From the Guidelines
Premenstrual dysphoric disorder (PMDD) should be treated with selective serotonin reuptake inhibitors (SSRIs) as the first-line medication therapy, given its efficacy in reducing symptoms. According to the latest classification of psychiatric disorders 1, PMDD is characterized by a pattern of mood symptoms, somatic symptoms, or cognitive symptoms that begin several days before the onset of menses, start to improve within a few days after the onset of menses, and then become minimal or absent within 1 week following the onset of menses.
Key Characteristics of PMDD
- Mood symptoms such as depressed mood
- Somatic symptoms like overeating
- Cognitive symptoms including forgetfulness
Treatment Options
- Lifestyle modifications: regular exercise, stress management, and dietary changes
- Medication therapy: SSRIs like fluoxetine, sertraline, or escitalopram, which can be taken continuously or only during the luteal phase
- Hormonal treatments: combined oral contraceptives containing drospirenone
- Supplements: calcium and vitamin B6 may provide additional symptom relief
Pathophysiology
PMDD likely results from abnormal sensitivity to normal hormonal fluctuations affecting serotonin and GABA neurotransmitter systems.
Treatment Approach
Treatment should be individualized, with medication trials lasting at least 2-3 menstrual cycles to properly assess effectiveness, as noted in the context of psychiatric classification changes 1.
From the Research
Definition and Symptoms of Premenstrual Dysphoric Disorder
- Premenstrual dysphoric disorder (PMDD) is a severe type of premenstrual syndrome (PMS) that causes physical, psychological, and social symptoms in women of reproductive age 2.
- Symptoms of PMDD occur during the two weeks leading up to menstruation (the luteal phase) and can include irritability, anxiety, depression, and physical symptoms such as breast tenderness and bloating 3, 4.
Treatment of Premenstrual Dysphoric Disorder with Selective Serotonin Reuptake Inhibitors (SSRIs)
- SSRIs are increasingly used as a treatment for PMDD and have been shown to be effective in reducing symptoms 2, 3, 4, 5, 6.
- SSRIs can be administered either in the luteal phase or continuously, and both methods have been shown to be effective 2, 3, 6.
- The most common SSRIs used to treat PMDD are fluoxetine, paroxetine, sertraline, and citalopram 2, 3, 4, 5, 6.
Efficacy of SSRIs in Reducing Symptoms of PMDD
- Studies have shown that SSRIs are effective in reducing overall self-rated premenstrual symptoms in women with PMDD 2, 3, 6.
- SSRIs have also been shown to be effective in reducing specific symptoms such as psychological, physical, and functional symptoms, as well as irritability 3, 6.
- The efficacy of SSRIs in reducing symptoms of PMDD is thought to be due to their ability to enhance serotonergic action, which can help to improve mood and reduce symptoms 4.
Adverse Effects of SSRIs
- Common adverse effects of SSRIs include nausea, insomnia, sexual dysfunction, fatigue, and dizziness 2, 3, 5.
- The risk of adverse effects is dose-related, and higher doses of SSRIs are associated with a greater risk of adverse effects 3.
- The overall certainty of the evidence for the adverse effects of SSRIs is moderate, and the main weakness is poor reporting of study methodology 2.