What are the treatment options for Premenstrual Dysphoric Disorder (PMDD)?

From the Guidelines

Treatment options for Premenstrual Dysphoric Disorder (PMDD) should prioritize selective serotonin reuptake inhibitors (SSRIs) as the first-line medication treatment, with consideration of hormonal treatments and lifestyle approaches as adjunctive or alternative therapies, as supported by the most recent evidence from 1.

Key Treatment Options

• Medication: SSRIs such as fluoxetine (20mg daily), sertraline (50-150mg daily), or escitalopram (10-20mg daily) are recommended as first-line treatment, which can be taken continuously or only during the luteal phase.
• Hormonal Treatments: Combined hormonal contraceptives, particularly those containing drospirenone like Yaz or Yasmin, are effective for PMDD.
• Lifestyle Approaches: Cognitive behavioral therapy, regular exercise (30 minutes daily), dietary changes (reducing caffeine, alcohol, salt, and sugar), stress management techniques, and supplements like calcium (1200mg daily) and vitamin B6 (50-100mg daily) can be beneficial.

Rationale

The treatment of PMDD aims to address the abnormal response to normal hormonal fluctuations, with SSRIs helping to regulate serotonin levels that influence mood, and hormonal treatments stabilizing hormone fluctuations. A combination approach often yields the best results, and treatment should be individualized based on symptom severity and patient preferences, as indicated by 1 and other studies 1.

Considerations

• For women not responding to SSRIs, low-dose anxiolytics like alprazolam (0.25mg three times daily) may be used short-term during symptomatic days.
• Non-pharmacological approaches can be used as adjunctive or alternative therapies, especially for patients who prefer not to use medication or have not responded to pharmacologic treatments.
• The most recent and highest quality study 1 provides the strongest evidence for guiding treatment decisions in PMDD, emphasizing the importance of considering both pharmacologic and non-pharmacologic options.

From the FDA Drug Label

Premenstrual Dysphoric Disorder Sertraline treatment should be initiated with a dose of 50 mg/day, either daily throughout the menstrual cycle or limited to the luteal phase of the menstrual cycle, depending on physician assessment While a relationship between dose and effect has not been established for PMDD, patients were dosed in the range of 50 to 150 mg/day with dose increases at the onset of each new menstrual cycle

The treatment options for Premenstrual Dysphoric Disorder (PMDD) include sertraline, which can be administered at a dose of 50 mg/day, either daily throughout the menstrual cycle or limited to the luteal phase. The dose can be increased up to 150 mg/day if necessary, with increases made at the onset of each new menstrual cycle 2.

• Key points:
  • Initial dose: 50 mg/day
  • Dose range: 50 to 150 mg/day
  • Administration: Daily throughout the menstrual cycle or limited to the luteal phase
  • Dose increases: At the onset of each new menstrual cycle
• Important consideration: The effectiveness of sertraline in long-term use (more than 3 menstrual cycles) has not been systematically evaluated in controlled trials 2.

From the Research

Treatment Options for Premenstrual Dysphoric Disorder (PMDD)

The treatment options for PMDD include:

• Selective serotonin reuptake inhibitors (SSRIs) such as sertraline, fluoxetine, and paroxetine 3, 4, 5, 6, 7
• Cognitive behavioral therapy (CBT) 4
• Oral contraceptives, including drospirenone 4

Medication Treatment

Medications used to treat PMDD include:

• SSRIs, which have been shown to be effective in reducing symptoms of PMDD 3, 5, 6, 7
• Sertraline, which has been shown to be effective in reducing symptoms of PMDD when taken during the symptomatic interval 3
• Fluoxetine, which has been shown to be effective in reducing symptoms of PMDD when taken continuously or during the luteal phase 5, 6

Non-Medication Treatment

Non-medication treatments for PMDD include:

• CBT, which has been shown to be effective in reducing functional impairment and symptoms of PMDD 4
• Lifestyle changes, such as regular exercise and a healthy diet, which may help alleviate symptoms of PMDD

Administration of Treatment

Treatment can be administered in different ways, including:

• Continuous daily dosing, which has been shown to be more effective than luteal phase administration 7
• Luteal phase administration, which involves taking medication only during the luteal phase of the menstrual cycle 3, 5, 6
• Symptom-onset dosing, which involves taking medication only during the symptomatic interval 3