1. Home>
2. Specialties>
3. General Medicine>
4. Summary and Comment

Premenstrual Fluoxetine for Premenstrual Dysphoric Disorder

Two weeks of premenstrual fluoxetine effectively alleviated mood-related and physical symptoms in women with PMDD.

In premenstrual dysphoric disorder (PMDD), disabling emotional and physical symptoms appear during the week before menses (late luteal phase) and remit following onset of menses (follicular phase). Results of several studies have documented the efficacy of serotonin reuptake inhibitors for treating this disorder (Journal Watch Sep 30 1997), and daily fluoxetine is the only FDA-approved therapy for PMDD. In this manufacturer-sponsored, multicenter, placebo-controlled trial, investigators evaluated whether premenstrual fluoxetine use, starting 14 days before the next expected menses and continuing only through the first full day of bleeding, also is effective.

A total of 260 women (age range, 18 to 45) with PMDD (i.e., those with 50% increases in PMDD symptom scores from the follicular to the luteal phase) were randomized to receive 10-mg fluoxetine, 20-mg fluoxetine, or placebo daily for approximately 2 weeks before menses for 3 cycles. During 3 months of treatment, 20-mg fluoxetine was associated with significant improvement in total symptom scores compared with placebo, whereas 10-mg fluoxetine was not. Compared with placebo, both fluoxetine doses were associated with improved mood-related symptoms, but the 20-mg dose was associated with improved physical symptoms as well.

Comment: These results confirm findings from smaller studies, which have indicated that premenstrual daily fluoxetine is effective for treating PMDD. The rapidity with which PMDD patients responded suggests that the mechanism is different from the mechanism by which fluoxetine acts to relieve depression.

— Robert W. Rebar, MD

Published in Journal Watch General Medicine September 17, 2002

Citation(s):

Cohen LS et al. Premenstrual daily fluoxetine for premenstrual dysphoric disorder: A placebo-controlled, clinical trial using computerized diaries. Obstet Gynecol 2002 Sep; 100:435-44.

• Medline abstract (Free)