Selective serotonin reuptake inhibitors for premenstrual syndrome

Abstract

BackgroundThis is a substantive update of a previous review. Severe premenstrual syndrome (PMS) affects between 3% to 5% of women of reproductive age. Severe PMS is classified under the Diagnostic and Statistical Manual of Mental Disorders as premenstrual dysphoric disorder (PMDD). Selective serotonin reuptake inhibitors (SSRIs) are increasingly used as front-line therapy for PMS. A systematic review was undertaken on the efficacy of SSRIs in the management of severe PMS, or PMDD, to assess the evidence for this treatment option. ObjectivesThe objective of this review was to evaluate the effectiveness of SSRIs in reducing premenstrual syndrome symptoms in women diagnosed with severe premenstrual syndrome. Search strategyElectronic searches for relevant randomised controlled trials were undertaken in the Cochrane Menstrual Disorders and Subfertility Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EM-BASE, PsycInfo, and CINAHL (March 2008). Where insufficient data were presented in a report the original authors were contacted for further details. Selection criteriaAll trials were considered in which women with a prospective diagnosis of PMS, PMDD or late luteal phase dysphoric disorder (LPDD) were randomised to receive SSRIs or placebo for the treatment of premenstrual syndrome in a blinded trial. Data collection and analysisForty randomised controlled trials were identified which reported the use of SSRIs in the management of PMS. Fifty-six trials were excluded. The review authors extracted the data independently and estimated standardised mean differences for continuous outcomes.

Clinical Subtypes of Premenstrual Syndrome and Responses to Sertraline Treatment

“…These findings are consistent with other clinical trials and a previous meta-analysis of SSRI treatment for this disorder (3). In contrast, symptom-based subtypes differed significantly in response to sertraline treatment, with significant improvement in the mixed subtype and no significant improvement relative to placebo in the physical symptom subtype.…”

Clinical Subtypes of Premenstrual Syndrome and Responses to Sertraline Treatment

“…These findings are consistent with other clinical trials and a previous meta-analysis of SSRI treatment for this disorder (3). In contrast, symptom-based subtypes differed significantly in response to sertraline treatment, with significant improvement in the mixed subtype and no significant improvement relative to placebo in the physical symptom subtype.…”

Recording and treatment of premenstrual syndrome in UK general practice: a retrospective cohort study

“…Our study, however, by covering a longer period allowed better observation of the changes in the type of PMS treatment prescribed over time with SSRIs and COCs superseding progestogen and oestrogen as the preferred treatments for PMS in primary care after 1999. The increasing use of SSRIs and decreasing use of progestogen in primary care is largely in line with the evolving evidence base for PMS treatments with a number of meta-analyses and guidelines supporting the effectiveness of SSRIs 6 7 and questioning the effectiveness of progestogens. 6 8 The increased prescribing of COCs is somewhat surprising given the limited evidence supporting their efficacy in the treatment of PMS.…”

“…The increasing use of SSRIs and decreasing use of progestogen in primary care is largely in line with the evolving evidence base for PMS treatments with a number of meta-analyses and guidelines supporting the effectiveness of SSRIs 6 7 and questioning the effectiveness of progestogens. 6 8 The increased prescribing of COCs is somewhat surprising given the limited evidence supporting their efficacy in the treatment of PMS. 9 23 24 The limited evidence supporting the efficacy of oestrogen treatment for PMS 25 26 and concerns surrounding its safety may explain the considerable decline in its use in the treatment of PMS.…”

Nightmares Fluctuate Across the Menstrual Cycle and May be More Pronounced in Women With Premenstrual Syndrome

“…selective serotonin reuptake inhibitors (SSRIs) are commonly recommended for the treatment of PMS symptoms, including mood swings and irritability, as highlighted in the Cochrane review on this topic (Brown et al. 2009). In this study, two patients were taking SSRIs, and two others were on a serotonin‐norepinephrine reuptake inhibitor (SNRI), meaning that more than half of the sample was on antidepressant treatment.…”

Clinical Subtypes of Premenstrual Syndrome and Responses to Sertraline Treatment

“…These findings are consistent with other clinical trials and a previous meta-analysis of SSRI treatment for this disorder (3). In contrast, symptom-based subtypes differed significantly in response to sertraline treatment, with significant improvement in the mixed subtype and no significant improvement relative to placebo in the physical symptom subtype.…”

Recording and treatment of premenstrual syndrome in UK general practice: a retrospective cohort study

“…Our study, however, by covering a longer period allowed better observation of the changes in the type of PMS treatment prescribed over time with SSRIs and COCs superseding progestogen and oestrogen as the preferred treatments for PMS in primary care after 1999. The increasing use of SSRIs and decreasing use of progestogen in primary care is largely in line with the evolving evidence base for PMS treatments with a number of meta-analyses and guidelines supporting the effectiveness of SSRIs 6 7 and questioning the effectiveness of progestogens. 6 8 The increased prescribing of COCs is somewhat surprising given the limited evidence supporting their efficacy in the treatment of PMS.…”

“…The increasing use of SSRIs and decreasing use of progestogen in primary care is largely in line with the evolving evidence base for PMS treatments with a number of meta-analyses and guidelines supporting the effectiveness of SSRIs 6 7 and questioning the effectiveness of progestogens. 6 8 The increased prescribing of COCs is somewhat surprising given the limited evidence supporting their efficacy in the treatment of PMS. 9 23 24 The limited evidence supporting the efficacy of oestrogen treatment for PMS 25 26 and concerns surrounding its safety may explain the considerable decline in its use in the treatment of PMS.…”

Nightmares Fluctuate Across the Menstrual Cycle and May be More Pronounced in Women With Premenstrual Syndrome

“…selective serotonin reuptake inhibitors (SSRIs) are commonly recommended for the treatment of PMS symptoms, including mood swings and irritability, as highlighted in the Cochrane review on this topic (Brown et al. 2009). In this study, two patients were taking SSRIs, and two others were on a serotonin‐norepinephrine reuptake inhibitor (SNRI), meaning that more than half of the sample was on antidepressant treatment.…”

Clinical Subtypes of Premenstrual Syndrome and Responses to Sertraline Treatment

“…These findings are consistent with other clinical trials and a previous meta-analysis of SSRI treatment for this disorder (3). In contrast, symptom-based subtypes differed significantly in response to sertraline treatment, with significant improvement in the mixed subtype and no significant improvement relative to placebo in the physical symptom subtype.…”

Recording and treatment of premenstrual syndrome in UK general practice: a retrospective cohort study

“…Our study, however, by covering a longer period allowed better observation of the changes in the type of PMS treatment prescribed over time with SSRIs and COCs superseding progestogen and oestrogen as the preferred treatments for PMS in primary care after 1999. The increasing use of SSRIs and decreasing use of progestogen in primary care is largely in line with the evolving evidence base for PMS treatments with a number of meta-analyses and guidelines supporting the effectiveness of SSRIs 6 7 and questioning the effectiveness of progestogens. 6 8 The increased prescribing of COCs is somewhat surprising given the limited evidence supporting their efficacy in the treatment of PMS.…”

“…The increasing use of SSRIs and decreasing use of progestogen in primary care is largely in line with the evolving evidence base for PMS treatments with a number of meta-analyses and guidelines supporting the effectiveness of SSRIs 6 7 and questioning the effectiveness of progestogens. 6 8 The increased prescribing of COCs is somewhat surprising given the limited evidence supporting their efficacy in the treatment of PMS. 9 23 24 The limited evidence supporting the efficacy of oestrogen treatment for PMS 25 26 and concerns surrounding its safety may explain the considerable decline in its use in the treatment of PMS.…”

Nightmares Fluctuate Across the Menstrual Cycle and May be More Pronounced in Women With Premenstrual Syndrome

“…selective serotonin reuptake inhibitors (SSRIs) are commonly recommended for the treatment of PMS symptoms, including mood swings and irritability, as highlighted in the Cochrane review on this topic (Brown et al. 2009). In this study, two patients were taking SSRIs, and two others were on a serotonin‐norepinephrine reuptake inhibitor (SNRI), meaning that more than half of the sample was on antidepressant treatment.…”