From the FDA Drug Label
It is also marketed for the treatment of premenstrual dysphoric disorder (Sarafem®, fluoxetine hydrochloride). The answer to treating premenstrual depression is fluoxetine.
- Key points:
- Fluoxetine is marketed for the treatment of premenstrual dysphoric disorder.
- Premenstrual dysphoric disorder is related to premenstrual depression. 1
From the Research
Premenstrual depression can be effectively treated with selective serotonin reuptake inhibitors (SSRIs), with continuous administration being probably more effective than luteal phase administration, as evidenced by a recent systematic review 2. The treatment of premenstrual depression involves a combination of lifestyle modifications and medication.
- First-line treatment includes SSRIs such as fluoxetine (20mg daily), sertraline (50-150mg daily), or escitalopram (10-20mg daily), which can be taken either continuously or just during the luteal phase (typically 7-14 days before menstruation) 2.
- Lifestyle changes that help include regular exercise (30 minutes of moderate activity most days), maintaining a balanced diet low in sugar and salt, limiting caffeine and alcohol, and practicing stress-reduction techniques like meditation or yoga.
- Calcium supplements (1200mg daily) and vitamin B6 (50-100mg daily) have shown modest benefits 3.
- For some women, hormonal contraceptives, particularly those containing drospirenone like Yaz, can help stabilize mood fluctuations.
- Cognitive behavioral therapy is also effective, especially when combined with medication, as it addresses the underlying psychological factors contributing to premenstrual depression 3. These treatments work primarily by addressing the hormonal fluctuations and serotonin changes that occur premenstrually, which are believed to trigger depressive symptoms in susceptible individuals.
- The most recent and highest quality study, a 2024 systematic review, found that SSRIs probably reduce premenstrual symptoms in women with PMS and PMDD, with moderate-certainty evidence, and are probably more effective when taken continuously compared to luteal phase administration 2.
- However, SSRI treatment probably increases the risk of adverse events, with the most common being nausea, asthenia, and somnolence, highlighting the need for careful consideration and monitoring of treatment side effects 2.