Options for treating premenstrual dysphoric disorder, from the Harvard Mental Health Letter

Many women have premenstrual syndrome, a wide range of physical or emotional symptoms that occur before the monthly menstrual cycle. For about 5% of women of childbearing age, though, the symptoms are so severe that they cause significant mental distress and interfere with work, school, or relationships. This is called premenstrual dysphoric disorder (PMDD). Although sometimes dismissed as trivial, PMDD can disrupt a woman's life so much that she may consider suicide. Fortunately, treatment options exist for PMDD, reports the October 2009 issue of the Harvard Mental Health Letter. Antidepressants that slow the reuptake of serotonin, a brain chemical involved in mood, are effective for many women with PMDD. Options include selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa) and fluoxetine (Prozac); venlafaxine (Effexor), a serotonin and norepinephrine reuptake inhibitor (SNRI); and clomipramine (Anafranil), a tricyclic antidepressant that has a strong effect on serotonin. These drugs work on PMDD more quickly than on depression, so women don't necessarily have to take them every day. Instead, the drugs can be taken for the 14-day span that begins just after ovulation and ends with menstruation. Although progesterone supplements are often prescribed for PMDD, there is no evidence that low levels of this hormone contribute to the disorder. Largely because of side effects, hormone therapy strategies such as oral contraceptives, estrogen, and gonadotropin-releasing hormone agonists are considered second-line treatments for PMDD.
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