Expert Guidelines for the Treatment of Severe PMS, PMDD, and Comorbidities: The Role of SSRIs

Abstract

The hallmark feature of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) is the predictable, cyclic nature of symptoms or distinct on/offness that begins in the late luteal phase of the menstrual cycle and remits shortly after the onset of menstruation. PMDD is distinguished from PMS by the severity of symptoms, predominance of mood symptoms, and role dysfunction, particularly in personal relationships and marital/family domains. Several treatment modalities are beneficial in PMDD and severe PMS, but the selective serotonin reuptake inhibitors (SSRIs) have emerged as first-line therapy. The SSRIs can be administered continuously throughout the entire month, intermittently from ovulation to the onset of menstruation, or semi-intermittently with dosage increases during the late luteal phase. These guidelines present practical treatment algorithms for the use of SSRIs in women with pure PMDD or severe PMS, PMDD and underlying subsyndromal clinical features of mood or anxiety, or premenstrual exacerbation of a mood/anxiety disorder.

Premenstrual Dysphoric Disorder: Burden of Illness and Treatment Update

“…If medication is necessary, SSRI medication is considered the first-line treatment. 2,46,191 SSRI medication may be effective when administered continuously or intermittently (from ovulation to menses). With the recent FDA approval of the oral contraceptive YAZ for women with PMDD desiring oral contraception, there may now be an alternative first-line treatment.…”

“…It is generally recommended that clinicians treat the underlying disorder first, and if premenstrual symptoms persist, subsequent daily ratings can identify PMDD. 46 Symptoms of endometriosis, polycystic ovary disease, thyroid disorders, adrenal system disorders, hyperprolactinemia and panhypopituitarism may mimic symptoms of PMS.…”

“…In these women, the SSRI dosage is increased during the luteal phase and decreased back to the usual dosage at menses. 46 Future studies are also indicated to systematically compare the efficacy and predictors of response to symptom-onset, luteal-phase and continuous daily SSRI dosing in women with PMDD.…”

Hormonal therapy and depression: Are we overlooking an important therapeutic alternative?

“…PMDD may be distinguished from PMS by symptom severity, predominance of mood symptoms, and dysfunction in interpersonal relationships [11]. Throughout the article we will now refer to MRD as recently suggested [12].…”

Comparison of the Effect of Melissa officinalis Capsule and Care Educational Programs on the Intensity of Physical, Mental and Social Symptoms of Premenstrual Syndrome in High School Female Students

“…Some other studies also stated biological, psychological and socio-cultural reasons in this regard (18). The changes in the level of estrogen, progesterone, androgens and prolactin were considered more important in the PMS syndrome etiology, and brain serotonin production has particularly the central role in this issue (19). Different methods are recommended for relief from this syndrome.…”