Skip to main content
Log in

Current update of hormonal and psychotropic drug treatment of premenstrual dysphoric disorder

  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

This review discusses the current status of diagnosis and treatment of premenstrual dysphoric disorder (PMDD), with an emphasis on studies that have been published in the medical literature during the 2001 to 2002 interval. Serotonergic antidepressants are effective for PMDD, and are currently considered the first-line treatment. Recent clinical trials have shown that selective serotonin reuptake inhibitors, taken only during the symptomatic luteal phase, are also effective for PMDD. One study reported efficacy for a slow-release formulation of fluoxetine that was taken two times during the menstrual cycle. Oral contraceptives still lack definitive evidence of efficacy as a treatment for PMDD, although a new contraceptive formulation has appeared promising for the mood and behavioral symptoms of the disorder. The results of a meta-analysis of the published trials of progesterone and progestins further indicate that these hormones are not effective in the management of PMDD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 4. Washington, DC: American Psychiatric Association; 1994.

    Google Scholar 

  2. Born L, Steiner M: Current management of premenstrual syndrome and premenstrual dysphoric disorder. Curr Psychiatry Rep 2001, 3:463–469.

    PubMed  CAS  Google Scholar 

  3. Moline ML, Kahn DA, Ross RW, et al.: Premenstrual dysphoric disorder: a guide for patients and families. Postgrad Med 2001, 110:108–109.

    Google Scholar 

  4. Cronje WH, Studd JW: Premenstrual syndrome and premenstrual dysphoric disorder. Prim Care 2002, 29:1–12.

    PubMed  Google Scholar 

  5. Halbreich U: Premenstrual syndromes: closing the 20th century chapters. Cur Opin Obstet Gynecol 1999, 11:265–270.

    Article  CAS  Google Scholar 

  6. Endicott J, Amsterdam J, Eriksson E, et al.: Is premenstrual dysphoric disorder a distinct clinical entity? J Womens Health Gend Based Med 1999, 8:663–679.

    PubMed  CAS  Google Scholar 

  7. Eriksson E, Andersch B, Ho HP, et al.: Diagnosis and treatment of premenstrual dysphoria. J Clin Psychiatry 2002, 63(suppl):16–23.

    PubMed  Google Scholar 

  8. Wittchen HU, Becker E, Leib R, Krause P: Prevalence, incidence and stability of premenstrual dysphoric disorder in the community. Psychol Med 2002, 32:119–132. A prospective, longitudinal study of a large cohort that identifies the prevalence of PMDD and a larger group of "near-threshold" cases, which are relevant for clinical care.

    PubMed  CAS  Google Scholar 

  9. Angst J, Sellaro R, Merikangas KR, Endicott J: The epidemiology of perimenstrual psychological symptoms. Acta Psychiatr Scand 2001, 104:110–116.

    Article  PubMed  CAS  Google Scholar 

  10. Cohen LS, Miner C, Brown E, et al.: Premenstrual daily fluoxetine for PMDD: a placebo-controlled, clinical trial using computerized diaries. Obstet Gynecol 2002, 100:435–444. A large, multicenter trial that reports efficacy of luteal phase dosing with an SSRI.

    Article  PubMed  CAS  Google Scholar 

  11. Harrison WM, Endicott J, Rabkin JG, et al.: Treatment of premenstrual dysphoria with alprazolam and placebo. Psychopharmacol Bull 1987, 23:1501–1553.

    Google Scholar 

  12. Woods NF, Mitchell ES, Lentz MJ: Social pathways to premenstrual symptoms. Res Nurs Health 1995, 18:225–237.

    Article  PubMed  CAS  Google Scholar 

  13. Eriksson E, Andersch B, Ho H-P, et al.: Premenstrual dysphoria: an illustrative example of how serotonin modulates sexsteroid-related behavior. CNS Spectrums 2001, 6:141–149.

    Google Scholar 

  14. Hylan TR, Sundell K, Judge R: The impact of premenstrual symptomatology on functioning and treatment-seeking behavior: experience from the United States, United Kingdom, and France. J Womens Health Gend Based Med 1999, 8:1043–1052.

    PubMed  CAS  Google Scholar 

  15. Hartlage SA, Arduino KE: Toward the content validity of premenstrual dysphoric disorder: do anger and irritability more than depressed mood represent treatment-seekers’ experiences? Psychol Rep 2002, 90:189–202.

    Article  PubMed  Google Scholar 

  16. Kent J, Papp LA, Martinez JM, et al.: Specificity of panic response to CO2 inhalation in panic disorder: a comparison with major depression and premenstrual dysphoric disorder. Am J Psychiatry 2001, 158:58–67. A controlled laboratory challenge study that shows that the response of PMDD subjects to carbon dioxide inhalation differs from the response of depressed subjects, and is nearly identical to the response of panic patients.

    Article  PubMed  CAS  Google Scholar 

  17. Rubinow DR, Schmidt PJ, Roca CA: Estrogen-serotonin interactions: implications for affective regulation. Biol Psychiatry 1998, 44:839–850.

    Article  PubMed  CAS  Google Scholar 

  18. Parry BL: The role of central serotonergic dysfunction in the aetiology of premenstrual dysphoric disorder. CNS Drugs 2001, 14:277–285. A current review focused on the hypothesis that serotonergic dysregulation contributes to the pathogenesis of PMDD.

    Article  Google Scholar 

  19. Dimmock PW, Wyatt KM, Jones PW, Shaughn O’Brien PM: Efficacy of selective serotonin-reuptake inhibitors in premenstrual syndrome: a systematic review. Lancet 2000, 356:1131–1136. A meta-analysis of published studies of SSRIs for PMS and PMDD treatment. The results support the use of SSRIs as a first-line treatment for PMDD.

    Article  PubMed  CAS  Google Scholar 

  20. Steiner M, Romano SJ, Babcock S, et al.: The efficacy of fluoxetine in improving physical symptoms associated with premenstrual dysphoric disorder. BJOG 2001, 108:462–468.

    Article  PubMed  CAS  Google Scholar 

  21. Steiner M, Steinberg S, Stewart D, et al.: Fluoxetine in the treatment of premenstrual dysphoria. N Engl J Med 1995, 332:1529–1534.

    Article  PubMed  CAS  Google Scholar 

  22. Wood SH, Mortola JF, Chan YF, et al.: Treatment of premenstrual syndrome with fluoxetine: a double-blind, placebocontrolled, crossover study. Obstet Gynecol 1992, 80:339–344.

    PubMed  CAS  Google Scholar 

  23. Menkes DB, Taghavi E, Mason PA: Fluoxetine treatment of severe premenstrual syndrome. BMJ 1992, 305:346–347.

    PubMed  CAS  Google Scholar 

  24. Ozeren S, Corakci A, Yucesoy I, et al.: Fluoxetine in the treatment of premenstrual syndrome. Eur J Obstet Gynecol Reprod Biol 1997, 73:167–170.

    Article  PubMed  CAS  Google Scholar 

  25. Su TP, Schmidt PJ, Danaceau MA, et al.: Fluoxetine in the treatment of premenstrual dysphoria. Neuropsychopharmacol 1997, 16:346–356.

    Article  CAS  Google Scholar 

  26. Pearlstein TB, Stone AB, Lund SA: Comparison of fluoxetine, bupropion, and placebo in the treatment of premenstrual dysphoric disorder. J Clin Psychopharmacol 1997, 17:261–266.

    Article  PubMed  CAS  Google Scholar 

  27. Freeman EW, Rickels K, Sondheimer SJ, Polansky M: Differential response to antidepressants in women with premenstrual syndrome/premenstrual dysphoric disorder: a randomized controlled trial. Arch Gen Psychiatry 1999, 56:932–939.

    Article  PubMed  CAS  Google Scholar 

  28. Yonkers KA, Halbreich U, Freeman E, et al.: Symptomatic improvement of premenstrual dysphoric disorder with sertraline treatment: a randomized controlled trial. JAMA 1997, 278:983–988.

    Article  PubMed  CAS  Google Scholar 

  29. Young SA, Hurt PH, Benedek DM, Howard RS: Treatment of premenstrual dysphoric disorder with sertraline during the luteal phase: a randomized, double-blind, placebo-controlled crossover trial. J Clin Psychiatry 1998, 59:76–80.

    PubMed  CAS  Google Scholar 

  30. Jermain DM, Preece CK, Sykes RL, et al.: Luteal phase sertraline treatment for premenstrual dysphoric disorder: results of a double blind, placebo-controlled, crossover study. Arch Fam Med 1999, 8:328–332.

    Article  PubMed  CAS  Google Scholar 

  31. Halbreich U, Smoller JW: Intermittent luteal phase sertraline treatment of dysphoric premenstrual syndrome. J Clin Psychiatry 1997, 58:399–402.

    PubMed  CAS  Google Scholar 

  32. Eriksson E, Hedberg A, Andersch B, Sundblad C: The SRI paroxetine is superior to the noradrenaline reuptake inhibitor maprotiline in the treatment of premenstrual syndrome: a placebo-controlled trial. Neuropsychopharmacology 1995, 12:167–176.

    Article  PubMed  CAS  Google Scholar 

  33. Wikander I, Sundblad C, Andersch B, et al.: Citalopram in premenstrual dysphoria: is intermittent treatment during luteal phases more effective than continuous medication throughout the menstrual cycle? J Clin Psychopharmacol 1998, 18:390–398.

    Article  PubMed  CAS  Google Scholar 

  34. Freeman EW, Rickels K, Yonkers KA, et al.: Venlafaxine in the treatment of premenstrual dysphoric disorder. Obstet Gynecol 2001, 98:737–744. The results of this clinical trial indicate that venlafaxine is an effective treatment for PMDD, adding this medication to the group of serotonergic antidepressants that have demonstrated efficacy for the disorder.

    Article  PubMed  CAS  Google Scholar 

  35. Sundblad C, Modigh K, Andersch B, et al.: Clomipramine effectively reduces premenstrual irritability and dysphoria: a placebo-controlled trial. Acta Psychiatr Scand 1992, 85:39–47.

    PubMed  CAS  Google Scholar 

  36. Sundblad C, Hedberg M, Eriksson E: Clomipramine administered during the luteal phase reduces the symptoms of premenstrual syndrome: a placebo controlled trial. Neuropsychopharmacology 1993, 9:133–145.

    PubMed  CAS  Google Scholar 

  37. Kodesh A, Katz S, Lerner AG, et al.: Intermittent, luteal phase nefazodone treatment of premenstrual dysphoric disorder. J Psychopharmacol 2001, 15:58–60.

    Article  PubMed  CAS  Google Scholar 

  38. Freeman EW, Rickels K, Sondheimer SJ, et al.: Nefazodone in the treatment of premenstrual syndrome: a preliminary study. J Clin Psychopharmacol 1994, 14:180–186.

    Article  PubMed  CAS  Google Scholar 

  39. Landen M, Eriksson O, Sundblad C, et al.: Compounds with affinity for serotonergic receptors in the treatment of premenstrual dysphoria: a comparison of buspirone, nefazodone and placebo. Psychopharmacology (Berl) 2001, 155:292–298.

    Article  CAS  Google Scholar 

  40. Henney JE: New indication for fluoxetine. JAMA 2000, 284:1234.

    Article  CAS  Google Scholar 

  41. Freeman EW, Jabara S, Sondheimer SJ, Auletto R: Citalopram in PMS patients with prior SSRI treatment failure: a preliminary study. J Womens Health Gend Based Med 2002, In press.

  42. Kennedy SH, Eisfeld BS, Dickens SE, et al.: Antidepressantinduced sexual dysfunction during treatment with moclobemide, paroxetine, sertraline and venlafaxine. J Clin Psychiatry 2000, 61:276–281.

    Article  PubMed  CAS  Google Scholar 

  43. Sundstrom-Poromaa I, Bixo M, Bjorn I, Nordh O: Compliance to antidepressant drug therapy for treatment of premenstrual syndrome. J Psychosom Obstet Gynaecol 2000, 21:205–211.

    Article  PubMed  CAS  Google Scholar 

  44. Steiner M, Korzekwa M, Lamont J, Wilkins A: Intermittent fluoxetine dosing in the treatment of women with premenstrual dysphoria. Psychopharmacol Bull 1997, 33:771–774.

    PubMed  CAS  Google Scholar 

  45. Sundblad C, Hedberg MA, Eriksson E: Clomipramine administered during the luteal phase reduces the symptoms of premenstrual syndrome: a placebo-controlled trial. Neuropsychopharmacology 1993, 9:133–145.

    PubMed  CAS  Google Scholar 

  46. Judge R, Brown E, Miner C, Dillon J: Intermittent fluoxetine dosing in premenstrual dysphoric disorder [abstract]. World J Biol Psychiatry 2001, 2(suppl):204S.

    Google Scholar 

  47. Halbreich U, Bergeron R, Freeman E, et al.: Intermittent luteal phase dosing of sertraline effective in PMDD. Int J Neuropsychopharmacol 2000, 3(suppl):S248.

    Google Scholar 

  48. Miner C, Brown E, McCray S, et al.: Weekly luteal-phase dosing with enteric-coated fluoxetine 90 mg in premenstrual dypshoric disorder: a randomized, double-blind, placebocontrolled clinical trial. Clin Ther 2002, 24:417–433. This report indicates that a high-dose, slow-release formulation administered at two points in the menstrual cycle effectively reduced the symptoms of PMDD.

    Article  PubMed  CAS  Google Scholar 

  49. Brown SK, Doster JA, Rubino-Watkins MF, et al.: Psychosocial implications of oral contraceptive use. Prim Psychiatry 2000, 7:56–66.

    Google Scholar 

  50. Halbreich U: Hormones as treatments: hormonal interventions with psychopharmacological potential: an overview. Psychopharmacol Bull 1997, 33:281–286.

    PubMed  CAS  Google Scholar 

  51. Brown CS, Parker N, Ling F, Wan J: Sertraline in contraceptive users with premenstrual dysphoric disorder. Obstet Gynecol 2000, 95(suppl):S29.

    Google Scholar 

  52. Freeman EW, Rickels K, Sondheimer SJ, Polansky M: Concurrent use of oral contraceptives with antidepressants for premenstrual symptoms. J Clin Psychopharm 2001, 21:540–542.

    Article  CAS  Google Scholar 

  53. Brown CS, Ling FW, Farmer RG, Stone BF: Buspirone in the treatment of premenstrual syndrome. Drug Ther Suppl 1990, 112:121.

    Google Scholar 

  54. Rickels K: Buspirone in clinical practice. J Clin Psychiatry 1990, 51(suppl):51–54.

    PubMed  Google Scholar 

  55. Rickels K, Freeman E, Sondheimer S: Buspirone in treatment of premenstrual syndrome. Lancet 1989, 1:777.

    Article  PubMed  CAS  Google Scholar 

  56. Schmidt PJ, Nieman LK, Danaceau MA, et al.: Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome. N Engl J Med 1998, 338:209–216. An important study that indicates that the symptoms of women with severe premenstrual syndrome respond to hormonal manipulation in contrast to women with no PMS.

    Article  PubMed  CAS  Google Scholar 

  57. Brown CS, Ling FW, Andersen RN, et al.: Efficacy of depot leuprolide in premenstrual syndrome: effect of symptom severity and type in a controlled trial. Obstet Gynecol 1994, 84:779–786.

    PubMed  CAS  Google Scholar 

  58. Freeman EW, Sondheimer SJ, Rickels K: Gonadotropin-releasing hormone agonist in treatment of premenstrual symptoms with and without ongoing dysphoria: a controlled study. Psychopharmacol Bull 1997, 33:303–309.

    PubMed  CAS  Google Scholar 

  59. Hammarback S, Bäckström T: Induced anovulation as treatment of premenstrual tension syndrome: a double-blind cross-over study with GnRH-agonist versus placebo. Acta Obstet Gynecol Scand 1988, 67:159–166.

    PubMed  CAS  Google Scholar 

  60. Hussain SY, Massil JH, Matta WH, et al.: Buserelin in premenstrual syndrome. Gynecol Endocrinol 1992, 6:57–64.

    PubMed  CAS  Google Scholar 

  61. Leather AT, Studd JWW, Watson NR, Holland EFN: The treatment of severe premenstrual syndrome with goserelin with and without "addback" estrogen therapy: a placebo-controlled study. Gynecol Endocrinol 1999, 13:48–55.

    Article  PubMed  CAS  Google Scholar 

  62. Mortola JF, Girton L, Fischer U: Successful treatment of severe premenstrual syndrome by combined used of gonadotropinreleasing hormone agonist and estrogen/progestin. J Clin Endocrinol Metab 1991, 71:252–257.

    Article  Google Scholar 

  63. Mezrow G, Shoupe D, Spicer D, et al.: Depot leuprolide acetate with estrogen and progestin add-back for long-term treatment of premenstrual syndrome. Fertil Steril 1994, 62:932–937.

    PubMed  CAS  Google Scholar 

  64. Di Carlo C, Palomba S, Tommaselli GA, et al.: Use of leuprolide acetate plus tibolone in the treatment of severe premenstrual syndrome. Fertil Steril 2001, 75:380–384.

    Article  PubMed  Google Scholar 

  65. Freeman EW, Kroll R, Rapkin A, et al.: Evaluation of a unique oral contraceptive in the treatment of premenstrual dysphoric disorder. J Womens Health Gend Based Med 2001, 10:561–569.

    Article  PubMed  CAS  Google Scholar 

  66. Kahn LS, Halbreich U: Oral contraceptives and mood. Expert Opin Pharmacother 2001, 2:1367–1382. A current and extensive review of the associations of oral contraceptives and mood.

    Article  PubMed  CAS  Google Scholar 

  67. American College of Obstetrics and Gynecology: ACOG Practice Bulletin: premenstrual syndrome. Int J Gynecol Obstet 2001, 73:183–190. The most recent update of the Practice Bulletin for the clinical management of premenstrual syndrome, prepared by the American College of Obstetricians and Gynecologists.

    Article  Google Scholar 

  68. Wyett K, Dimmock P, Jones P, et al.: Efficacy of progesterone and progestogens in management of premenstrual syndrome: systematic review. BMJ 2001, 323:776–780. A meta-analysis of 14 published studies of progesterone and progestins that indicates that these hormones have no role in the clinical management of PMDD.

    Article  Google Scholar 

  69. Schellenberg R: Treatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomized, placebo controlled study. BMJ 2001, 322:134–137.

    Article  PubMed  CAS  Google Scholar 

  70. Berger D, Schaffner W, Schrader E, et al.: Efficacy of vitex agnus castus L extract Ze 440 in patients wih premenstrual syndrome (PMS). Arch Gynecol Obstet 2000, 264:150–153.

    Article  PubMed  CAS  Google Scholar 

  71. Loch EG, Selle H, Boblitz N: Treatment of premenstrual syndrome with a phytopharmaceutical formulation containing vitex agnus castus. J Womens Health Gend Based Med 2000, 9:315–320.

    Article  PubMed  CAS  Google Scholar 

  72. Stevinson C, Ernst E: A pilot study of hypericum perforatum for the treatment of premenstrual syndrome. BJOG 2000, 107:870–876.

    Article  PubMed  CAS  Google Scholar 

  73. Stevinson C, Ernst E: Complementary/alternative therapies for premenstrual syndrome: a systematic review of randomized controlled trials. Am J Obstet Gynecol 2001, 185:227–235. An extensive review of 27 trials of complementary and alternative therapies for premenstrual syndrome. The results indicate that there is no consistent scientific evidence for the efficacy of any of the therapies examined. These included herbal medicines, dietary supplements and a number of single studies of other alternative treatments.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Freeman, E.W. Current update of hormonal and psychotropic drug treatment of premenstrual dysphoric disorder. Curr Psychiatry Rep 4, 435–440 (2002). https://doi.org/10.1007/s11920-002-0071-0

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-002-0071-0

Keywords

Navigation