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

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.

A Reproductive Subtype of Depression

“…Moreover, other progestins used alone or as part of an OCP failed to show a clear benefit, consistent with earlier evidence that older progestin preparations are ineffective in PMDD 70,89. Although it is plausible that drospirenone may have unique therapeutic effects in women with PMDD, another factor that may play an important role in the efficacy of OCPs containing drospirenone is that they have shorter hormone-free intervals compared to older OCP preparations.…”

Anxiety Disorders Among Women: A Female Lifespan Approach

“…There is little research on SSRIs specifically for premenstrual anxiety, although one small study showed a significant 45.4% decrease in Hamilton Anxiety Scale (HAM-A) score after four weeks of sertraline treatment among women with PMDD (132). While hormonal contraceptives may influence aspects of anxiety response, there is limited evidence for the efficacy of hormonal treatment for premenstrual mood symptoms (133–135). Some women report worsening of premenstrual mood symptoms with hormonal contraceptives (136–138).…”

Reproduktion und Psyche

“…Auch wenn von einer multifaktoriellen Genese der prämenstruellen dysphorischen Störung ausgegangen werden muss, ist dem Einfluss des Serotoninsystems eine relevante Bedeutung beizumessen. Dies erklärt auch, warum Antidepressiva, die dieses System beeinflussen (serotonerge Antidepressiva, wie etwa Serotonin-Wiederaufnahme-Hemmer, SSRI) wirksam sind [33,34,35]. In einer Vielzahl placebokontrollierter Doppelblinduntersuchungen wurde die Wirkung nahezu aller verfügbaren serotonergen Substanzen belegt.…”