Premenstrual syndrome (PMS) and especially its severe form, premenstrual
dysphoric disorder (PMDD), have been afflicting women for eons
(Psychiatric News, May 16, 2008).
So when the SSRI antidepressants were found to be effective for PMS and
PMDD, and when the Food and Drug Administration approved several SSRIs for
these ailments, many women had reason to celebrate.
But how long women must stay on an SSRI to keep PMS or PMDD at bay depends
on whether they have PMS or PMDD, a new study has found.
The lead investigator of the randomized, double-blind, placebo-controlled
study was Ellen Freeman, Ph.D., director of the PMS research program in the
University of Pennsylvania's Department of Obstetrics and Gynecology. Results
were published in the May Archives of General Psychiatry.
The study cohort consisted of 174 women with either PMS or PMDD. Half
received the SSRI sertraline for four months, the other half received
sertraline for an entire year. In all cases, 50 mg of sertraline a day was
given only to the women following ovulation during the luteal phase of the
menstrual period—the standard SSRI treatment for PMS or PMDD.
All subjects were then placed on a placebo and followed up for six months.
The researchers compared outcomes for the two groups of subjects.
During the six-month follow-up period, 51 percent of the short-term
treatment group relapsed, whereas only 33 percent of the long-term treatment
group did. But when baseline severity of symptoms was considered, those
subjects with PMDD relapsed two-thirds of the time, whereas those with PMS
relapsed only a third of the time regardless of how long they had been
So, "overall, women are less likely to relapse after stopping SSRIs
if treated for 12 months compared to four months," Freeman told
Psychiatric News. "[But] severity of the symptoms is an
important consideration. Women with severe symptoms are likely to relapse
after stopping SSRIs regardless of the duration of medication."
Freeman and her colleagues likewise found that just as subjects with PMDD
were especially prone to relapse, so were those subjects with a history of
depression (about half the sample). So are women who have PMDD the same women
who are also subject to depression? "No," Freeman said."
There is likely overlap between the disorders, but PMDD is not
Suppose a patient has both PMDD and a history of depression. What SSRI
regimen would most benefit her? "Carefully monitor her to determine the
symptoms and severity over the entire menstrual cycle—not just
premenstrual—and carefully evaluate her response to the dosing
regimen," Freeman advised. "If premenstrual dosing does not
sufficiently control symptoms, then daily dosing, possibly with an increase in
the premenstrual phase, should be tried."
Still, "no definitive studies" have been conducted to date to
determine whether PMDD per se is better countered by taking an SSRI during the
entire menstrual cycle, not just during the luteal phase, Freeman noted.
The study was funded by the National Institute of Child Health and Human
An abstract of "Time to Relapse After Short- or Long-Term
Treatment of Severe Premenstrual Syndrome With Sertraline" is posted at<http://archpsyc.ama-assn.org/cgi/content/abstract/66/5/537>.▪