PREMENSTRUAL SYNDROME
and PREMENSTRUAL DYSPHORIC DISORDER
I. Proven effective in placebo-controlled trials:
Programmed relaxation (Obs. Gyn 75:649,
1990)
Serotonin Reuptake Inhibitor
Antidepressants
Associated with sig. benefit in a meta-analysis of 15 randomized
placebo-controlled trials with OR of improvement 6.91 with SRI's c/w
placebo; Lancet 356:1131, 2000--JW)
In
a trial of 167 women 18-45 with PMS randomized to sertaline 50-100mg/d
given QD continuously vs. intermittently (starting 14d before menses
and continuing until 2d after menses) vs. placebo, x 3mos. No
diff. in treatment response or adverse events between the two
sertraline groups; both had higher incidence of treatment response
than placebo group for the first 2mos but by the end of the 3rd month
the difference was nonsignificant (Am. J. Psychiat. 161:454, 2004--JW)
Calcium supplementation: 497 women with
PMS randomized to CaCO3 (1.2g/d of elemental Ca) vs.
placebo x 3 menstrual cycles; Ca group had sig. lower sx
scores than placebo group by 3rd cycle (Am. J. Obs. Gyn.
179:444, 1998--JW)
Vitamin B6 at doses of 50-100mg/d
appeared more effective than placebo in a meta-analysis
of 9 randomized trials involving 940 pts (BMJ 318:1375,
1999--JW)
Magnesium 360mg PO QD (Obs. Gyn 78:177,
1991, cited in Contraceptive Tech.)
Evening
Primrose Oil (Efamol) 1500mg BID from 15th cycle
day to menses-provides gamma-linoleic acid and vit. E ;
esp. helpful for mastalgia (J. Repro. Med 30:149, 1985,
cited in CT)
Chaste Tree
Extract (Vitex agnus-castus)--170 women meeting
DSM III-R criteria for PMS randomized to V. agnus-castus
"L extract Ze 440" (20mg casticin QD) vs. placebo x 3
menstrual cycles; sig. greater improvement in sx in active vs.
placebo group; no diff. in adverse effects in active vs. placebo groups
(BMJ 322:134, 2001--JW)
OCP's may be helpful
Progestins probably not helpful--In a meta-analysis of 14
randomized trials of progestins for PMS involving total 909 women, only
minimal differences in PMS-related symptoms were noted (BMJ 323:776,
2001--JW)
II. Premenstrual Dysphoric Disorder is "a syndrome of
severe and disabling mood sx that occur before menses." Meds
found effective:
- Sertraline 50-150mg/d vs. placebo (randomized
double-blind) in 243 women w/PMDD was ass'd with greater
improvements in physical & depressive sx (JAMA
278:983, 1997-JW)
- Fluoxetine 20-60mg/d sig. better than placebo at reducing
PMDD sx (NEJM 332:1529, 1995--Med. Lett.); may be as
effective to take it for only the 2wks before menses as
through the entire cycle (Psychopharm. Bull. 33:771,
1997--Med. Lett.; Obs. Gyn. 100:435, 2002--JW)
- Venlafaxine also shown to be more effective than placebo
(Med. Lett. 43:5, 2001)
- Ditto Citalopram and Paroxetine (Int. Clin. Psychopharm.
14 suppl. 2:S27, 1999--Med. Lett.)
- Oral Contraceptives may be helpful (in one placebo-controlled trial
using a drospirenone-ethinyl estradiol OCP; Obs. Gyn 106:492, 2005--JW)