From the FDA Drug Label
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 Patients not responding to a 50 mg/day dose may benefit from dose increases (at 50 mg increments/menstrual cycle) up to 150 mg/day when dosing daily throughout the menstrual cycle, or 100 mg/day when dosing during the luteal phase of the menstrual cycle
The treatment guidelines for Premenstrual Dysphoric Disorder (PMDD) with sertraline involve initiating treatment with a dose of 50 mg/day. The dosing can be either continuous (daily throughout the menstrual cycle) or intermittent (limited to the luteal phase of the menstrual cycle), depending on the physician's assessment.
- The preferred dosing is not explicitly stated, but both continuous and intermittent dosing regimens are mentioned as options.
- Dose increases can be made in 50 mg increments per menstrual cycle, up to a maximum of 150 mg/day for continuous dosing or 100 mg/day for intermittent dosing. 1
From the Research
The first-line treatment for premenstrual dysphoric disorder (PMDD) is selective serotonin reuptake inhibitors (SSRIs), with continuous dosing generally preferred over intermittent dosing, as it probably reduces overall self-rated premenstrual symptoms in women with PMDD and is probably more effective when taken continuously compared to luteal phase administration 2.
Treatment Guidelines
The recommended SSRIs for PMDD include:
- Fluoxetine (20-60 mg/day)
- Sertraline (50-150 mg/day)
- Paroxetine (20-30 mg/day)
- Citalopram (20-30 mg/day)
- Escitalopram (10-20 mg/day) These medications work by increasing serotonin levels in the brain, which helps regulate mood, behavior, and anxiety.
Dosing Preferences
Continuous dosing involves taking the medication daily throughout the menstrual cycle, providing more consistent symptom relief and may be particularly beneficial for women with severe symptoms or those who experience symptoms throughout their cycle. Intermittent dosing (taking medication only during the luteal phase, typically 7-14 days before menses) can be considered for women with milder symptoms or those who experience side effects with continuous treatment.
Alternative Treatments
For women who don't respond to SSRIs, alternative treatments include:
- Hormonal interventions such as combined oral contraceptives (particularly those containing drospirenone like Yaz)
- GnRH agonists with add-back hormone therapy
- Anxiolytics like alprazolam for severe anxiety symptoms Lifestyle modifications including regular exercise, stress management techniques, and dietary changes (reducing caffeine, alcohol, and salt) should be incorporated alongside pharmacological treatment.
Adverse Effects
The most common adverse effects associated with SSRIs include:
- Nausea
- Insomnia
- Sexual dysfunction or decreased libido
- Fatigue or sedation
- Dizziness or vertigo
- Tremor
- Somnolence and decreased concentration
- Sweating
- Dry mouth
- Asthenia or decreased energy
- Diarrhea
- Constipation These adverse effects are generally dose-related and may be more frequent with higher doses of SSRIs 2.