Womens Health, Fitness, Weight Loss, Beauty and More

Selective serotonin reuptake inhibitors (SSRIs) for PMS and PMDD

Examples

Brand Name: Celexa

Chemical Name: citalopram

Brand Name: Prozac, Sarafem

Chemical Name: fluoxetine hydrochloride

Brand Name: Luvox

Chemical Name: fluvoxamine

Brand Name: Paxil, Paxil CR (controlled release)

Chemical Name: paroxetine hydrochloride

Brand Name: Zoloft

Chemical Name: 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

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

SSRIs are often the first-choice medication 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 medication need only be taken during the premenstrual phase, generally 2 weeks before the start of menstrual bleeding.

How Well It Works

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 medication.2, 3

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

Side Effects

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.4 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 with taking triptans, used for migraines, with SSRIs (selective serotonin reuptake inhibitors) or SNRIs (selective serotonin/norepinephrine reuptake inhibitors). Taking these medicines together can cause a serious condition called serotonin syndrome.
What To Think About

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 medication, some medications can adversely interact with an SSRI. Discuss your medication 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 medications can cause flu-like symptoms, headaches, nervousness, anxiety, or insomnia.

5 Questions Women Don’t Ask Their Doctors

Women everywhere dread going to the OBGYN. It’s not just the cold metal stirrups. Sometimes invasive medical procedures can make us anxious to get out of the office ASAP. Meanwhile, some of the questions we were dying to ask the doctor are forgotten. If you’ve ever worried about your low sex drive or wondered what you can do for mild PMS, now’s the time to get your questions answered.

Q. I don’t enjoy sex very much because I often experience discomfort. Is there anything a doctor can do for this?

A. Physical and emotional factors alike can contribute to painful intercourse, or dyspareunia. Certainly there are gynecological conditions that manifest as sexual discomfort, and most of them can be resolved with a physician’s guidance. It’s important to be evaluated.

Common conditions represented by superficial pain include yeast infections, dryness and vulvodynia (pain in the vulva). Vaginismus, a spasmodic tightening of the vaginal muscles, can have roots in a medical malady or be a psychological reaction to sex.

If your pain is physically deeper, it could signal anything from ovarian cysts to endometriosis to a pelvic inflammatory disease. But don’t get spooked by the possibilities. Talk to a physician about your symptoms.

Q. I’m having trouble conceiving. What can my husband and I do before resorting to expensive treatments?

A. “Healthy bodies allow you to have a baby, and healthy bodies produce healthy babies,” says Jill Blakeway, a licensed acupuncturist and fertility specialist based in New York City. “It’s really not rocket science.”

Moms-to-be should exercise in moderation to reduce stress and achieve a comfortable body weight. Eat a lot of organic fruits and vegetables and other healthy foods. “We can be pretty sure that the collective burden of all the toxins and chemicals we take in on a regular basis stresses our reproductive cycle,” Blakeway explains.

Holistic solutions can be an excellent, affordable option. And remember, getting pregnant is a team effort. Women and men alike can give fertility a strong head start by minding the following:

Avoid alcohol
Avoid coffee
Eat healthy, unprocessed foods
Reduce stress
Don’t smoke
Don’t use marijuana or other drugs
Take multivitamins
Have sex!
Many factors will come into play—age, body weight, medical history—but there are several avenues of treatment to pursue. Not all are expensive, and you might even get some assistance from your insurance carrier.

Q. Is there anything I can do about my terrible PMS? I only have it a few days each month, but those days are wretched.

A. There are over 150 symptoms associated with premenstrual syndrome, from acne to swollen feet to wishing your spouse would get hit by a bus. But if you’re having extreme symptoms such as incapacitating pain, significant depression or cramps outside your normal cycle, consult a doctor to rule out more serious conditions.

Although there’s no cure-all, the right diet and exercise can bring physical and emotional relief.

Dial back the caffeine, which can bring on mood swings as well as breast soreness, and avoid alcohol. Reduce your intake of salt, sugar, fatty foods and red meat. Instead, seek sources of calcium, magnesium and vitamins B6 and E. The evidence on herbal remedies like primrose oil and chaste tree berry is anecdotal; some women swear by them, some swear at them.

Moderate aerobics (running, walking, swimming) and relaxation techniques (yoga, massage) tend to reduce fatigue, anxiety and depression.

While over-the-counter ibuprofen and diuretics can be helpful, there is better medical evidence that low doses of SSRIs—the same drugs used to counter depression—will relieve PMS symptoms effectively and rapidly.

Should I try an SSRI for premenstrual syndrome (PMS)?

What is premenstrual syndrome?
For as long as you have a menstrual cycle and ovulate, your hormone-producing endocrine system has powerful, cyclic effects on your body. While some women barely notice these effects, up to 85% of women normally have one or more premenstrual symptoms. These happen between the time you ovulate and the first days of your menstrual period.3 When premenstrual physical and emotional symptoms interfere with your relationships or responsibilities, they are called premenstrual syndrome (PMS). When these emotional symptoms or aggression become severe, it is called premenstrual dysphoric disorder (PMDD). In contrast to PMS, PMDD affects only 3% to 8% of women.4

Because a woman’s endocrine system is so complex, there are a number of possible hormones and other chemicals in the body that can trigger PMS symptoms. Serotonin is the best-known neurotransmitter chemical that impacts symptoms in many women with PMS. For many women, improving the brain’s use of serotonin helps relieve a number of emotional and physical PMS symptoms.

What are selective serotonin reuptake inhibitors (SSRIs)?
SSRIs are a class of medication that affects the brain’s use of the neurotransmitter serotonin. This improvement in serotonin use is known to improve physical and emotional PMS symptoms. SSRIs are also used to treat depression, anxiety, menopausal hot flashes, and chronic pain.

SSRIs are usually the first-choice medication for treating severe PMS and PMDD symptoms, including depression, anxiety, irritability, anger, mood swings, breast tenderness, bloating, headache, and joint and muscle pain. SSRI treatment only during the premenstrual phase appears to be as effective as continuous SSRI treatment.1 And, it costs less. If you have PMS symptoms that completely subside during your period, this approach is likely to work for you. But, if you have emotional symptoms of depression or anxiety all of the time, taking an SSRI continuously may be a better option for you.

Commonly used SSRIs for PMS include sertraline (Zoloft), fluoxetine (Prozac, Sarafem), paroxetine (Paxil), fluvoxamine (Luvox), and citalopram (Celexa). They each have slightly different effects on mood. While one SSRI may not be right for you, another SSRI may work well. SSRI therapy for PMS usually brings relief within a few days of starting medication but can take longer.3, 4

What are the side effects of SSRI treatment?
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.5 Some side effects will tend to subside over several weeks. Among women taking an SSRI for PMS, several side effects have been widely studied, including:

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.
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 SSRI should be watched for any 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.2