From the FDA Drug Label
The effectiveness of sertraline for the treatment of PMDD was established in two double-blind, parallel group, placebo-controlled flexible dose trials (Studies 1 and 2) conducted over 3 menstrual cycles 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 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
Treatment of PMDD: Sertraline is effective in the treatment of Premenstrual Dysphoric Disorder (PMDD). The recommended initial dose is 50 mg/day, which can be administered either daily throughout the menstrual cycle or limited to the luteal phase. Dose increases up to 150 mg/day or 100 mg/day may be necessary for patients who do not respond to the initial dose. 1 1
From the Research
Premenstrual dysphoric disorder (PMDD) should be treated with selective serotonin reuptake inhibitors (SSRIs) as the first-line treatment, with options including fluoxetine, sertraline, or escitalopram, taken either continuously or during the luteal phase, as evidenced by the most recent and highest quality study 2.
Treatment Options
The treatment of PMDD involves a range of approaches, including:
- Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (20-60mg daily), sertraline (50-150mg daily), or escitalopram (10-20mg daily) 2
- Hormonal treatments, including combined oral contraceptives, particularly those containing drospirenone like Yaz or Yasmin 3
- Lifestyle modifications, including regular exercise, stress management techniques, adequate sleep, and dietary changes such as reducing caffeine, alcohol, salt, and sugar intake
- Calcium (1200mg daily) and vitamin B6 (50-100mg daily) supplements may provide additional benefit 4
- Cognitive behavioral therapy specifically targeting PMDD symptoms can help women develop coping strategies 3
Rationale
The rationale for using SSRIs as the first-line treatment for PMDD is based on their ability to modulate serotonin levels, which are closely linked to mood regulation and are affected by estrogen and progesterone changes during the menstrual cycle 5. The most recent and highest quality study 2 provides moderate-certainty evidence that SSRIs reduce overall self-rated premenstrual symptoms in women with PMS and PMDD, and are probably more effective when taken continuously compared to luteal phase administration.
Considerations
When considering treatment options for PMDD, it is essential to take into account the individual patient's symptoms, medical history, and preferences. The patient should be accompanied to make a choice of treatment adapted to her symptoms, their severity, her history, her plans for procreation, contraindications, and her preferences 3. Additionally, the potential adverse effects of SSRIs, such as nausea, insomnia, and sexual dysfunction, should be carefully considered and monitored 2.