Mass General Hospital

Harvard Medical School

Calcium Less Effective than SSRI for PMDD and Severe PMS

About 75% of women with regular menstrual cycles report unpleasant physical or psychological symptoms premenstrually. For the majority of women, these symptoms are mild and tolerable. However, some women have more severe and disabling symptoms, or premenstrual dysphoric disorder (PMDD).  Several years ago, a large, multicenter trial of calcium supplementation found that calcium (600 mg twice a day) significantly reduced both the physical and emotional symptoms of PMS; however, it has not been clear whether calcium supplementation might be effective for more severe premenstrual symptoms or PMDD.

A recent study has compared the efficacy of calcium supplements to the serotonin reuptake inhibitor fluoxetine for the treatment of severe premenstrual symptoms or PMDD.

This was a relatively small study, including 39 women with at least 3 moderate to severe premenstrual symptoms.  The women were treated with the SSRI fluoxetine (10 mg twice daily), calcium carbonate (600 mg twice daily), or placebo over the course of 4 menstrual cycles.

Fluoxetine had clear therapeutic benefit for premenstrual symptoms, whereas the effect of calcium was much smaller.  While calcium supplementation might provide some benefit in certain women, this study indicates that SSRIs remain first line treatment for severe premenstrual symptoms and PMDD.

Ruta Nonacs, MD PhD

Yonkers KA, Pearlstein TB, Gotman N.  A Pilot Study to Compare Fluoxetine, Calcium, and Placebo in the Treatment of Premenstrual Syndrome.  J Clin Psychopharmacol. 2013 Aug 16. [Epub ahead of print]

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