Expert Guidelines for the Treatment of PMDD

Expert Guidelines for the Treatment of PMDD

By |2015-07-28T10:23:13+00:00August 31st, 2007|PMS and PMDD|22 Comments

In this review, guidelines for the treatment of PMDD are provided.

Selective serotonin reuptake inhibitors (SSRIs) are the most widely used pharmacologic agents for treating depression and anxiety disorders, and several have also emerged as first-line treatment for premenstrual dysphoric disorder (PMDD). In numerous clinical trials, SSRIs have demonstrated efficacy in reducing the physical and behavioral symptoms of PMDD and improving social and occupational functioning.

SSRIs may be given either intermittently or continuously.

The authors described 3 dosing strategies for SSRI use — continuous dosing (daily throughout the month), intermittent (luteal phase only) dosing, and semi-intermittent dosing (continuous with increased dose in the luteal phase) — and reviewed the results of 2 placebo-controlled studies that compared the efficacy of these dosing strategies. They also described the candidates who would be best suited for each dosing strategy.

Steiner M, Pearlstein T, Cohen LS, et al. Expert Guidelines for the Treatment of Severe PMS, PMDD, and Comorbidities: the Role of SSRIs. J Womens Health (Larchmt) 2006;15:57-69.


  1. Lara October 23, 2008 at 3:56 am

    I feel that as soon as the health global care profession stop treating PMS and PMDD as a psychological /psychiatric problem and start treating it as a physiological disease we will actually be on the way to getting some kind of effective treatment and relief for millions of handicapped and incapacitated women. I also, truly believe that if there were a disease or syndrome that affected and debilitated men in the same way as this horrible condition effects women we would be a lot further down the part to finding and actual cure or at least some form of effective treatment.

  2. lynne Rotherham October 26, 2008 at 1:48 pm

    Lara, can i ask you what your systems are and what you have tried to treat PMDD. I suffer and would like your comments…thanks lin

  3. Steven McNutt PharmD June 22, 2010 at 10:10 pm

    While not diagnosed as PMDD I see an increasing number of women aged 35 to 55 that are treated with Lexapro at low doses and have great success in treating the symptoms associated with PMDD. Because of insurance they are forced to try other less expensive generics usually with very poor results. Are there any studies out there for Lexapro on PMDD? Do not get me wrong as soon as a product is available generically I recommend it full force but….

  4. Julia September 11, 2010 at 12:27 am

    My PMDD is terrible. I am already on celexa, but have found this ineffective in treating my symptoms. If men knew what it was like, I am sure there would be a medication specifically designed to treat PMDD. Has anyone found any meds helpful?

  5. Lilia July 27, 2011 at 11:45 pm

    I have a 17 year old daughter that I believe suffers from pmdd. She is an angel most of the time but a week before she gets her period she gets moody, angry, doesnt sleep and sometimes gets violent, when she doesnt get her way once she gets her period she is an angel again. What can I do to help her ?

  6. Vixen September 27, 2011 at 7:04 am

    @Lara, Yes, I agree! Aaaahh!

  7. Lily October 11, 2011 at 7:28 am

    I am diagnosed with PMDD I have lost days and weeks to depression and crying for no reason, I have lost relationships and suffer socially, I lose focus and cannot concentrate at work impacting my typically high performance. I requested a “specialist” at my obgyn – she tried 2 different birth control pills and 1 anti depressant (Wellbutrin) – they haven’t worked and it has been 4 months. I tried eliminating all hormone therapies and used the paragaurd which is a non hormonal IUD – I bled for the entire month and suffered severe cramps most weeks. The next option is to induce menopause. I am 38…. this doesn’t seem to make sense

    Knowing the cause and not being able to fix it is the most frustrating part. I hate living like this. I feel like I am crazy. I eat healthy, I don’t drink excessively, I exercise, I see my doctor yet I feel hopeless.

    If anyone has any suggestions of a doctor, clinic, trial or anything please let me know – I am really tired of fighting.

  8. Gina October 27, 2011 at 11:02 am

    @Steven McNutt PharmD,

    I am 49 and have had horrible anxiety, depression, anger, tears and physical symptoms about two weeks befroe my period. This started when i was 42 and has gotten worse every year. I no longer work and have tired natural ways to overcome this problem. I am at the end of my rope. Should I try Lexapro? What is a good starting point dose?

  9. MGH Center for Women's Mental Health December 20, 2011 at 11:05 am

    @Lily, I am sorry to hear that you have such a bad run with PMDD, but I think there are some very good options which you have not yet tried.

    The data on the efficacy of using oral contraceptives for the treatment of PMDD are pretty mixed. Many women with PMDD report that they are not helpful.

    There is no data to support the use of bupropion (Wellbutrin) for the treatment of PMDD. Yes, bupropion is an antidepressant; however, it is only the serotonergic antidepressants that are beneficial for the treatment of PMDD. These include Prozac, Zoloft, Paxil, Celexa, Lexapro, Effexor and Cymbalta. It might be helpful for you to take a look at this page, which reviews the treatment of PMDD.

  10. MGH Center for Women's Mental Health December 20, 2011 at 2:47 pm

    We cannot really advise you on what medications to take. This is a discussion you should have with your own doctor who knows you best.

    That said, we know that SSRIs, such as Lexapro, are highly effective for the treatment of PMDD.

  11. Laura January 15, 2012 at 7:24 pm

    I have found that Black Cohash taken at ovulation until my period starts has completly taken care of the anxiety. It helps lessen the severe irritability as well. It does not help the negative thinking/depressive thoughts, argumentative thinking and social withdrawl.
    I work extremely hard at personal cognitive approaches, journaling, yoga, meditation and forcing myself to get out and continue with my regular routine. I also have to force myself to stay connected to close family members. These have not helped. Some months are better than others.
    Staying off sugar and “white foods” does help. I need to do this before ovulation. Once I start eating sugar during the second half of my cycle it is hard to
    I am considering trying medication. After all this hard work to still feel like a different person 2 weeks out of every month is not quality of life.

  12. Vixen January 20, 2012 at 9:24 pm

    @Laura, I go through the same EXACT thing every month.. Anti-depressants don’t help. Yoga can only do so much in the moment it is done. Journaling is not even close to a resolution. Aaah! I have found that Taurine has given me enough energy to get out of bed. Thanks for the tip on Black Cohosh…will try also.

  13. MGH Center for Women's Mental Health March 21, 2012 at 12:07 pm

    I am sorry to hear that you’re having difficulties finding treatment. I am not aware of any research in Norway on this topic. Sometimes gynecologists are more aware of these problems than psychiatrists, so that might be an option for you to pursue. Best of luck.

  14. Juliet Kaushik April 8, 2012 at 7:16 am

    Hi there,

    Are there any online forums or message boards for PMDD or PMS, where sufferers can share experiences?

    Thank you

  15. Casey C May 1, 2012 at 6:29 am

    I am 30yrs young & was diagnosed with PMDD approximately 4 years ago. I tried an array of treatments including acupuncture, herbs, diet, excise, yet ended up having to taking anti-depressants which did help. Unfortunately they have there own side effects. I took AD’s for 12 months then gradually weaned off them – up until now I have been able to manage symptoms well with diet exercise and stress reduction & by taking Harmony PMS support tablets. Recent pile of stress has exacerbated my symptoms once again & I am looking at having to go back on AD’s again until things are less stressful in my life.

    Does anyone have anything they can suggest to try????

  16. Vix May 7, 2012 at 1:57 am

    @Casey C,

    I also have PMDD, and I’ve tried everything, including anti-depressants, Yaz, herbs, etc.

    The ONLY thing that has ever helped is TAURINE.

    I buy the 500 MG capsules. And I can not believe the change..I can live a normal life now.

    Please try this! It’s amazing!

  17. MGH Center for Women's Mental Health May 7, 2012 at 9:44 am

    @Juliet Kaushik, iVillage has some PMS boards.

  18. Lisa D October 2, 2012 at 11:58 am

    Hi, I’m wondering if there are any specialists at Mass General or in the Boston area who focus on PMDD. I have been suffering in many of the same ways others have written about here. I have been ‘diagnosed’ by my PCP, GYN and therapist. The impact on my life is costing more and more the longer I go ‘untreated.’ I have tried dietary shifts, water pills, ‘self-crating’ on the days I am affected but this isn’t practical or possible regularly.

    Nobody seems to have a specialized body of knowledge regarding PMDD in my care group. I am interested in talking to anyone in the Boston, MA – USA area who does. I am about to move toward an SSRI out of desperation but I feel wary due to the fact that nobody seems to know EXACTLY what will work. I feel like I’m tossing a dart toward a board with a blindfold on.


  19. Jay S October 5, 2012 at 8:35 pm

    If Cymbalta can be used as intermittent treatment for PMDD, what minimum dose do you recommend?

  20. Maxine March 26, 2013 at 10:37 am

    My doctor prescribed Effexor in low dose when I came to her explaining I did not like the way my mood changed two weeks prior to my period. This was approximately 8 years ago. I had been told I was also having early menopause symptoms because of night sweats etc.

    A few years later, I began seeing a hormone replacement Dr. He helped a lot, but my GP indicated I was spending additional money I did not need to spend. He regularly tested my blood and kept all hormone levels balanced. Eventually she took me off all hormones as she felt it was too long to be on them.I finally caved and let her treat me and went into a world wind of problems.

    I ended up with a migraine which they thought was a stroke with a frozen right side for several minutes. I still have migraines constantly now. Then memory loss came on very severe, insomnia, weight gain, depression, anxiety, that has been so severe over the past few years I was suicidal.

    My period stopped for a full year. I switched GP.s and was put back on Estrogen. It did help. Then she tried all different variations of anxiety meds. I went back to the hormone Dr. and am on Prometrium, and a blend of hormone cream. My period is back and extremely irregular. I still have many days of feeling hopeless and helpless. I went from being extremely outgoing to so withdrawn I do not like seeing family at most times never mind friends or working. This has been the worst time of my life. I would not wish this on anyone.
    All I want is to feel like I did before menopause, I never dreamed it could be this hell.

  21. Sally June 10, 2015 at 6:41 pm

    Hi, I’ve just been given a script of Lexapro for treatment of my PMDD. I’ve never been on the this type of medication before. Im not one for taking medications except my vitamins.
    Before l approached my doctor I have tried other things like exercising ( yoga), vitamins, mediation, and seeing a counsellor.
    For years now though l have suffered extreme pain and dark moods around my period. It’s affected my relationships with family and my now partner greatly which l hold alot of guilt about.
    My partner is not to keen on me taking this medication, l guess with the stigma around it.
    Honestly l hate the thought l need to take a pill to make me ok. Now turning 40 and dealing with this for so long l need to try something.

    With the varied experiences I’ve been reading on Lexapro I’m concerned how it will affect me.
    I guess l won’t know till l try.
    My doctor as given me a dose to start with of 5mg 10 days before l start my period.
    I’m a little confused in your suppose to steadily come off the medication when you want to stop, so taking it 10 days before your period and during then stopping… Is that ok?
    Yes l might be abit vein in l don’t want to put on weight, because l feel good when l look good and comfortable in my own skin.
    Along with the other side effects like dry mouth etc l won’t know till l try.

    I take comfort in that l don’t seem to be alone, there are many women who have to deal with this consuming feeling in there lives.
    Any more comments and insight l would appreciate.

    I like to say thank you to all of you for taking the time on sharing your experiences. It really helps!

  22. smaa swiss lommeknive July 27, 2018 at 9:34 am

    G?eetings! Very useful advice within this post! It is the little changes that will make the biggest c?anges.
    Many thanks for sharing!

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