Is Celexa (citalopram) effective for treating premenstrual syndrome (PMS)?

Citalopram (Celexa) for Premenstrual Syndrome (PMS)

Citalopram (Celexa) is effective for treating premenstrual syndrome (PMS), with evidence supporting both continuous and luteal phase administration, though it appears to be more effective when taken continuously. 1

Efficacy of SSRIs for PMS

SSRIs, including citalopram, have been established as effective treatments for PMS and its more severe form, premenstrual dysphoric disorder (PMDD). The evidence shows:

• SSRIs reduce overall premenstrual symptoms with moderate effect sizes compared to placebo 1, 2
• They are particularly effective for psychological and behavioral symptoms that occur during the luteal phase 3
• SSRIs improve quality of life in women with PMS/PMDD 3

Administration Options

Two administration regimens are possible:

1. Continuous administration (daily throughout the menstrual cycle)

   • Likely more effective based on recent evidence 1
   • Provides consistent symptom relief

2. Luteal phase administration (only during the 2 weeks before menstruation)

   • Reduces medication exposure and lowers treatment costs 4
   • Still effective but possibly less so than continuous administration 1
   • May help avoid development of tolerance 5

Dosing Considerations

• Starting dose typically 10-20mg daily 6
• For continuous administration, maintain consistent daily dosing
• For luteal phase dosing, begin medication 14 days before expected menstruation and discontinue at onset of menses

Side Effects to Monitor

Common side effects include:

• Nausea (most common) 1, 2
• Insomnia 1
• Sexual dysfunction or decreased libido 1, 3
• Fatigue or sedation 1
• Dizziness 1
• Dry mouth 1
• Decreased energy 1

Important Precautions

• Pregnancy considerations: Discuss risks/benefits if pregnancy is possible
• Serotonin syndrome: Risk increases when combined with other serotonergic medications 6
• Discontinuation symptoms: May occur with abrupt cessation, though less reported with luteal phase dosing 4
• Monitoring: Regular follow-up to assess efficacy and side effects

Clinical Decision Making

When deciding on citalopram for PMS:

1. Confirm diagnosis: Ensure symptoms occur primarily during luteal phase and resolve with menstruation
2. Assess symptom severity: More severe symptoms (PMDD) may benefit more from continuous administration
3. Consider patient preferences: Discuss continuous vs. luteal phase administration options
4. Start with lower doses: Begin with 10mg daily and titrate as needed
5. Evaluate response: Assess after 1-2 menstrual cycles for efficacy

Alternative Options

If citalopram is ineffective or poorly tolerated, consider:

• Other SSRIs (sertraline, fluoxetine, paroxetine) 7
• Non-pharmacological approaches (cognitive behavioral therapy) 6

Common Pitfalls to Avoid

1. Misdiagnosis: Ensure symptoms are truly cyclical and related to menstrual cycle
2. Inadequate trial duration: Allow at least 1-2 cycles to assess efficacy
3. Ignoring side effects: Monitor and address side effects to improve adherence
4. Abrupt discontinuation: Taper medication if discontinuing after continuous use

Citalopram represents an evidence-based approach to managing PMS symptoms, with flexibility in administration that can be tailored to symptom pattern and severity.