Should I try an SSRI for premenstrual syndrome (PMS)?
on June 19th, 2008 at 10:50 pmWhat 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