Selective serotonin reuptake inhibitors (SSRIs) for PMS and PMDD

Examples

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Brand Name	Generic Name
Celexa	citalopram

Brand Name	Generic Name
Sarafem	fluoxetine hydrochloride

Brand Name	Generic Name
Luvox	fluvoxamine

Brand Name	Generic Name
Paxil CR (controlled release)	paroxetine hydrochloride

Brand Name	Generic Name
Zoloft	sertraline hydrochloride

You can take a selective serotonin reuptake inhibitor (SSRI) by mouth every day of the month. Or you can take an SSRI daily between the day you ovulate and the start of your period (usually about 2 weeks).¹

If you are trying to get pregnant, talk to your doctor about whether an SSRI is safe.

How It Works

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An SSRI affects the brain's use of a chemical messenger (neurotransmitter) called serotonin. This improvement in serotonin use is known to be connected to and to improve physical and emotional PMS symptoms, depression, anxiety, hot flashes, and chronic pain.

Why It Is Used

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SSRIs are often the first-choice medicine for treating severe premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) symptoms, including depression, anxiety, irritability, anger, mood swings, breast tenderness, bloating, headache, and joint and muscle pain.

For many women, SSRI medicine need only be taken during the premenstrual phase, generally 2 weeks before the start of menstrual bleeding.

How Well It Works

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Research shows SSRIs are very effective in relieving the emotional and physical PMS and PMDD symptoms for most women. SSRI therapy usually brings relief within a few days of starting medicine.²

Taking an SSRI only during the premenstrual phase appears to be as effective as continuous SSRI treatment.¹

Side Effects

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Side effects from SSRI treatment are usually not serious. But these side effects are fairly common, and they are why some people stop taking SSRI medicine.³ Some side effects will tend to improve over several weeks. SSRI side effects can include:

• Nausea, appetite changes, weight loss.
• Headache.
• Insomnia, fatigue.
• Nervousness.
• Difficulty with sexual desire, arousal, or orgasm.
• Dizziness.
• Tremors.
• Dry mouth.
• Rash (rare).
• Weight gain (rare) with long-term use.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

FDA Advisories. The U.S. Food and Drug Administration (FDA) has issued:

• An advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking an antidepressant should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when doses are changed.
• A warning about the antidepressants Paxil and Paxil CR and birth defects. Taking these medicines in the first 12 weeks of pregnancy may increase your chance of having a baby with a birth defect.
• A warning about taking triptans, used for headaches, with SSRIs (selective serotonin reuptake inhibitors) or SNRIs (selective serotonin/norepinephrine reuptake inhibitors). Taking these medicines together can cause a very rare but serious condition called serotonin syndrome.

What To Think About

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When considering SSRI treatment, compare possible SSRI benefits and effectiveness with possible side effects and costs of treatment. You can discuss this with your health professional.

SSRI treatment is not recommended if you have a seizure disorder or a history of mania (including bipolar disorder). These conditions can be made worse by an SSRI.

As with any medicine, some medicines can adversely interact with an SSRI. Discuss your medicine and dietary supplement use with your health professional before trying an SSRI.

When taking an SSRI continuously, never stop taking it abruptly. The long-term use of an SSRI should be tapered off slowly and only under the supervision of a health professional. Abruptly stopping SSRI medicines can cause flu-like symptoms, headaches, nervousness, anxiety, or insomnia.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. Freeman EW, et al. (2004). Continuous or intermittent dosing with sertraline for patients with severe premenstrual syndrome or premenstrual dysphoric disorder. American Journal of Psychiatry, 161(2): 343–351.

2. Katz VL, et al. (2007). Primary and secondary dysmenorrhea, premenstrual syndrome, and premenstrual dysphoric disorder. In LO Eckert, GM Lentz, eds., Comprehensive Gynecology, 5th ed., pp. 901–913. Philadelphia: Mosby Elsevier.

3. Kwan I, Onwude JL (2007). Premenstrual syndrome, search date November 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.

Credits

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Author	Sandy Jocoy, RN
Editor	Kathleen M. Ariss, MS
Associate Editor	Tracy Landauer
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Deborah A. Penava, BA, MD, FRCSC, MPH - Obstetrics and Gynecology
Last Updated	June 19, 2008