This study examines the relative effectiveness of cognitive behavior therapy (CBT) (ten sessions), fluoxetine (20 mg daily) and combined therapy (CBT plus fluoxetine) in women with premenstrual dysphoric disorder (PMDD). This was a randomized pragmatic treatment trial with three treatment cells. Treatment lasted for 6 months; a naturalistic follow-up was undertaken 1 year post-treatment. One hundred and eight women, satisfying the DSM-IV criteria for PMDD with 2 months' prospective confirmation were recruited into the study; sixty of these had completed 6 months of treatment and all measures before and after treatment. The main outcome measures were premenstrual scores on the Calendar of Premenstrual Experiences (COPE) and percentage of PMDD cases (DSM-IV diagnostic criteria). Significant improvement occurred in all three treatment-groups after 6 months' treatment, assessed by the COPE. Fluoxetine was associated with a more rapid improvement. There were no group differences in the percentage of DSM cases of PMDD post treatment, but at follow-up CBT was associated with better maintenance of treatment effects compared with fluoxetine. In conclusion, CBT and fluoxetine are equally effective treatments for PMDD, but the treatments have some differential effects that can be considered in treatment decisions. There appears to be no additional benefit of combining the treatments.

No abstract

A women-centred psychological intervention for premenstrual symptoms, drawing on cognitive-behavioural and narrative therapy, has been developed. In a randomized control trial previously reported, this treatment was found to be as effective as SSRIs in reducing moderate or severe premenstrual symptoms. The purpose of this paper is to outline the multifactorial model of premenstrual symptoms that underpinned this intervention, describe the treatment in detail session by session, and present two case examples drawing on narrative interviews conducted pre and post treatment with the women who took part in the randomized control trial, in order to illustrate the process of change. It is argued that premenstrual symptoms arise from a complex interaction of material, discursive and intrapsychic factors, and that this needs to be taken into account when designing clinical interventions.