Harvard Women's Health Watch

Will Prozac help my premenstrual depression?

Ask the doctor

Q. I've had some severe bouts of depression before my periods. I have done my own research and I am willing to try an antidepressant. What dosage of Sarafem or Prozac is usually given to treat this?

A. Selective serotonin reuptake inhibitors (SSRIs) are an excellent option for treating premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). In fact, most physicians now consider them first-line therapy. Many different SSRIs have been studied, including the one you asked about—fluoxetine (Prozac or Sarafem)—and they all appear to be equally effective.

SSRIs can be taken daily or just in the second half (luteal phase) of the menstrual cycle, starting at ovulation—usually day 14 of your cycle—and stopping with the onset of your period, unless symptoms last into your period. If the initial dose—usually 10 to 20 milligrams—doesn't work, your doctor may increase it. (You should wait several cycles to see if it works.) Some women who do not respond to one type of SSRI may respond to a different SSRI, so it is definitely worth trying more than one if the first one does not work after adjusting the dos-age and allowing enough time.

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