Large, randomised, placebo-controlled clinical trials – the most rigorous types of studies – have found that low doses of SSRIs, taken during just the last two weeks of the menstrual cycle, can greatly alleviate PMDD symptoms.
In one study published in 2005, for instance, researchers asked 373 women with PMDD to take a pill for each of the 14 days before menstruation for three months: One group took 12.5mg of the antidepressant paroxetine CR (Paxil-CR), a second group took 25mg of the same medication, and the third group took a placebo.
Of the 292 women who completed the trial, those in the antidepressant groups tolerated the drugs and reported significantly reduced symptoms of PMDD, with no major differences between the two doses.
“As long as you keep track of where you are in your cycle, that works really well,” Dr Deligiannidis said. Sertraline (Zoloft), fluoxetine (Prozac) and paroxetine (Paxil) have been approved by the US Food and Drug Administration to treat PMDD, but numerous trials of other SSRIs – like citalopram (Celexa), escitalopram (Lexapro) and fluvoxamine (Luvox) – have shown benefits, too.
Why these antidepressants are effective is still a bit of a mystery, Dr Deligiannidis said. “We know that SSRIs must be working a little bit differently than how they work for depression or anxiety disorders,” she said, since their benefits for those conditions can take weeks to kick in while for PMDD, symptoms can be relieved within days.
If you have PMDD and are already taking SSRIs, your doctor may recommend that you increase the dosage during just the lead-up to menstruation.