SAN FRANCISCO — Women with premenstrual dysphoric disorder usually respond rapidly to the first treatment cycle of an antidepressant, allowing intermittent dosing that follows the menstrual cycle, Dr. Andrea J. Singer said at Perspectives in Women's Health sponsored by OB.GYN. NEWS.
Three selective serotonin reuptake inhibitors (SSRIs) are approved for the treatment of premenstrual dysphoric disorder (PMDD)–fluoxetine, sertraline, and paroxetine. “You don't necessarily have to have people on these long term to see a benefit,” said Dr. Singer, director of women's primary care at Georgetown University Medical Center, Washington.
Dr. Singer is on the speakers' bureau of Pfizer Inc., which makes sertraline. OB.GYN. NEWS is published by the International Medical News Group, a division of Elsevier.
PMDD causes severe premenstrual symptoms that result in significant impairment of normal function, usually during the last 6–7 days of the menstrual cycle. American women with PMDD experience the symptoms on average for 8 years during their reproductive lives, she said.
Because the disorder is intermittent and treatment with an SSRI brings rapid onset of improvement, intermittent therapy is sufficient, which lowers medication costs and limits side effects, compared with treatment of overt depression. In addition, low doses typically are effective for PMDD.
Diagnosis of PMDD requires the exclusion of underlying overt depression and the presence of at least five symptoms, including at least one of four core symptoms: anger/irritability; depressed mood; moodiness; and anxiety/edginess/nervousness. Other symptoms include fatigue or lethargy, decreased interest in usual activities, insomnia or hypersomnia, difficulty concentrating, food cravings or appetite changes, feeling overwhelmed, headache, breast tenderness, bloating, and joint or muscle pain.
For women with PMDD on oral contraceptives, a pill containing drospirenone and ethinylestradiol improved PMDD symptoms in several studies. Other data suggest shortening the hormone-free interval during oral contraceptive regimens to 3–4 days can improve some symptoms.