When symptoms persist despite lifestyle changes and other conditions have been ruled out, selective serotonin reuptake inhibitors (SSRIs) have shown to provide a minimization of symptoms in some women with PMDD.
It is important to note that SSRIs work on a biological level. While fluoxetine (Prozac) may work well for one woman, sertraline (Zoloft) may work better for another. Blood and saliva tests are available to determine which antidepressant may work best for you. Click here to download an informational brochure to bring to your clinician.
SSRIs are a different class of medications than mood stabilizers. Mood stabilizers are not an appropriate line of treatment for women with PMDD.
Several members of the selective serotonin reuptake inhibitor (SSRI) class of medications have been approved by the FDA to treat the anxiety and depressive symptoms PMDD. These medications work by regulating the levels of the neurotransmitter serotonin in the brain and are often considered first-line treatment for this disorder. SSRIs that have shown to be effective in the treatment of PMDD include:
- fluoxetine (Prozac, Sarafem)
- sertraline (Zoloft)
- paroxetine (Paxil)
- citalopram (Celexa)
Up to 75% of women report relief of symptoms when treated with SSRI medications. Side effects can occur in up to 15% of women and include nausea, anxiety, and headache. SSRI medications to treat PMDD may be prescribed to be taken continuously or only during the 14-day luteal phase (second half) of the menstrual cycle. Other types of antidepressants (tricyclic antidepressants and monoamine oxidase inhibitors) and lithium (Lithobid) have not been shown to be effective in the treatment of PMDD. Finding the right dosage is key to the effectiveness of SSRIs. This form of treatment has been shown to improve irritability, depressed mood, dysphoria, bloating, breast tenderness, appetite changes, and psychosocial function. Studies show that most SSRI treatment studies are short-term, lasting only during 3 to 6 consecutive menstrual cycles and that data on the long-term benefits are extremely limited.1,2
Women with PMDD are most often misdiagnosed with bipolar disorder (rapid cycling or otherwise) due to the cyclical nature of both disorders. Because of this tragic confusion, women are often prescribed medications to treat bipolar disorder called mood stabilizers. These medications include:
- carbamazepine (Tegretol)
- Divalproex (Epival)
- lamotrigine (Lamictal)
- Gabapentin (Neurontin)
- topiramate (Topamax)
The last three listed above are classified as "anticonvulsants" and are typically used "off label" alone or in addition to other medications. These drugs are classified as anti-psychotic medications and have potential risks when used long-term and/or incorrectly in the wrong amounts or for the wrong disorders. In short, mood stabilizers are not approved nor appropriate for the treatment of PMDD. 8,9,10
There is no single option that works for all women with PMDD. You will want to work with your health care and support team to find the best treatment option for you.
Many women find it is a combination of several treatment options that help the most.
There are several options for treatment that are currently prescribed to manage symptoms of PMDD. Some have been proven to be effective and others have not. Some may lessen symptoms in the short term and others may have no effect or worsen symptoms over time. Always consult with your medical team before stopping or starting any medications or treatments.