Low Doses of Anti-Depressant May Help PMS

Some women who experience moderate-to-severe premenstrual syndrome may benefit from treatment with low doses of anti-depressant medication, according to a new study led by a Virginia Commonwealth University researcher.

In the October issue of the Journal of Clinical Psychiatry, researchers reported that low doses of sertraline taken for two weeks before the onset of the menstrual period may be an effective and well-tolerated treatment for some women who experience moderate-to-severe premenstrual syndrome, or PMS.

The researchers also tested and found two other anti-depressant dosing strategies to be effective. One of those dosing strategies was taking medication daily throughout the menstrual cycle. The other was waiting until PMS symptoms begin to start medication each cycle, which is known as 'symptom-onset' dosing. Sertraline is a selective serotonin reuptake inhibitor (SSRI) approved for the treatment of depression and anxiety, as well as for premenstrual dysphoric disorder (PMDD), a severe form of premenstrual syndrome.

"Our study is the first to evaluate the use of low-dose antidepressant medication for women who have moderate-to-severe PMS, and the first placebo-controlled study to include the novel dosing strategy of 'symptom-onset dosing,'" said Susan G. Kornstein, M.D., a professor of psychiatry and obstetrics and gynecology in VCU's School of Medicine and lead author on the study.

"Our findings suggest that women with less severe forms of PMS than PMDD may also benefit from treatment with antidepressant medication, and they may be able to take medication only on the days that they are symptomatic," she said.

Up to 60 percent of women suffer from PMS, while only about 5 percent of women suffer from PMDD. PMS symptoms may include irritability, depressed mood, anxiety and mood swings, in addition to physical symptoms such as bloating and breast tenderness. PMDD is characterized by severe mood symptoms that interfere with functioning.

Previous research studies have focused on the use of anti-depressants for PMDD. According to Kornstein, women with less severe symptoms have not received as much attention in treatment studies, although calcium supplementation has been shown to be helpful.

Kornstein and her colleagues evaluated approximately 300 women with PMS from 22 sites throughout the United States. The participants were randomly assigned to fixed-dose treatment with 25 or 50 mg of sertraline or given a placebo for four menstrual cycles.

This work was funded by Pfizer, Inc.

Kornstein, is executive director of VCU's Institute for Women's Health, designated a National Center of Excellence by the U.S. Department of Health and Human Services, and director of the VCU Mood Disorders Institute. She collaborated with Teri B. Pearlstein, M.D., from Brown University School of Medicine; and Rana Fayyad, Ph.D., Gail M. Farfel, Ph.D., and John A. Gillespie, Ph.D., who are researchers with Pfizer, Inc.