Intermittent Dosing Succeeds in Premenstrual Dysphoric Disorder


SAN FRANCISCO — Women with premenstrual dysphoric disorder usually respond rapidly to the first treatment cycle of an antidepressant, allowing intermittent dosing that follows the menstrual cycle, Dr. Andrea J. Singer said at a meeting on women's health sponsored by OB.GYN. NEWS.

Three selective serotonin reuptake inhibitors (SSRIs) are approved for the treatment of premenstrual dysphoric disorder (PMDD)—fluoxetine, sertraline, and paroxetine. “You don't necessarily have to have people on these long term to see a benefit,” said Dr. Singer, director of women's primary care at Georgetown University Medical Center, Washington.

Dr. Singer is on the speakers' bureau of Pfizer Inc., which makes sertraline.

PMDD causes severe premenstrual symptoms that result in significant impairment of normal function, usually during the last 6–7 days of the menstrual cycle. American women with PMDD experience the symptoms on average for 8 years during their reproductive lives—from 576 to 672 days, approximately. “That's a lot of days to feel lousy or be incapacitated,” Dr. Singer said.

Because the disorder is intermittent and treatment with an SSRI brings rapid onset of improvement, intermittent therapy is sufficient, which lowers medication costs and limits side effects, compared with treatment of overt depression. In addition, low doses typically are effective for PMDD.

A diagnosis of PMDD requires the exclusion of underlying overt depression and the presence of at least five symptoms, including at least one of four core symptoms—anger or irritability; depressed mood; moodiness; and anxiety/edginess/nervousness.

Other symptoms include fatigue or lethargy, decreased interest in usual activities, insomnia or hypersomnia, difficulty concentrating, food cravings or appetite changes, feeling overwhelmed or out of control, and physical symptoms such as headache, breast tenderness, bloating, and joint or muscle pain.

For women on oral contraceptives with PMDD, using a pill containing the novel progestin drospirenone and ethinylestradiol improved symptoms of PMDD in several studies. Other studies suggest that shortening the hormone-free interval during oral contraceptive regimens from the standard 7 days to 3–4 days can improve some PMDD symptoms, Dr. Singer said.

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