Expert guidelines for the treatment of severe PMS, PMDD, and comorbidities: The role of SSRIs

Department of Psychiatry & Behavioral Neurosciences, McMaster University, Women's Health Concerns Clinic, St. Joseph's Hospital, Hamilton, Ontario, Canada.
Journal of Women's Health (Impact Factor: 2.05). 01/2006; 15(1):57-69. DOI: 10.1089/jwh.2006.15.57
Source: PubMed


The hallmark feature of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) is the predictable, cyclic nature of symptoms or distinct on/offness that begins in the late luteal phase of the menstrual cycle and remits shortly after the onset of menstruation. PMDD is distinguished from PMS by the severity of symptoms, predominance of mood symptoms, and role dysfunction, particularly in personal relationships and marital/family domains. Several treatment modalities are beneficial in PMDD and severe PMS, but the selective serotonin reuptake inhibitors (SSRIs) have emerged as first-line therapy. The SSRIs can be administered continuously throughout the entire month, intermittently from ovulation to the onset of menstruation, or semi-intermittently with dosage increases during the late luteal phase. These guidelines present practical treatment algorithms for the use of SSRIs in women with pure PMDD or severe PMS, PMDD and underlying subsyndromal clinical features of mood or anxiety, or premenstrual exacerbation of a mood/anxiety disorder.

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    • "Despite the efficacy of SSRIs and a low-dose oral contraceptive in PMDD (Freeman et al. 2001; Steiner et al. 2006; Yonkers et al. 2005), non-response rates are ≥40 % (Freeman et al. 1999; Halbreich 2008; Steiner et al. 1995) and nearly 50 % of MRMD women prescribed SSRIs do not take them or discontinue within 6 months (Sundstrom-Poromaa et al. 2000). Research on behavioral interventions in MRMD is sparse, with three randomized trials (Blake et al. 1998; Hunter et al. 2002; Morse et al. 1991). "
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    ABSTRACT: Menstrually related mood disorders (MRMDs) are characterized by the cyclic recurrence of affective and somatic symptoms in the luteal phase of the menstrual cycle that result in substantial impairment. Despite the efficacy of SSRIs and a low-dose oral contraceptive, non-response rates are ≥40 %, and the need for a behavioral intervention in this population is warranted. This pilot study was conducted to determine the feasibility and acceptability of an 8-week mindfulness-based intervention for women with a MRMD. Self-report measures assessing pain catastrophizing, mindfulness, depression, anxiety, rumination, and self-compassion were completed before and after the intervention as were laboratory measures of pain sensitivity to a cold pressor and tourniquet procedure and cardiovascular responses to a mental stressor. In addition, premenstrual symptom severity ratings for 11 MRMD symptoms were assessed prospectively. Results indicated that, relative to pre-intervention levels, there was a significant decrease in symptom severity for seven of the 11 premenstrual symptoms, an increase in pain tolerance to the cold pressor, and a decrease in blood pressure reactivity to mental stress. The use of a historical control group supports that the effects for symptoms and pain sensitivity could not be accounted for by habituation to repeat testing. Further, 88 % of participants completed the study and all post-intervention measures, and all women reported that they used the stress reduction skills in the post-lab and in their daily lives. Mindfulness training provides a feasible, well-tolerated behavioral intervention that should be tested for efficacy in a larger randomized trial in women with a MRMD.
    Full-text · Article · Apr 2015 · Mindfulness
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    • "Management of moderate-severe premenstrual distress has traditionally focused on medical treatments, developing from irradiation of the ovaries [10], to serotonin reuptake inhibitors (SSRIs), as the primary pharmacological option [8,11]. This type of treatment assumes a purely biomedical view of premenstrual experience, positioning PMS and PMDD as fixed pathologies within the woman, caused by hormonal or neurotransmitter imbalance [12]. "
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    ABSTRACT: Negative premenstrual change can result in distress for a significant proportion of women. Previous research has suggested that women employ a range of coping strategies and behaviours in order to manage and reduce premenstrual distress. However, as yet there has been no specific scale available to measure premenstrual coping. This research aimed to develop and validate a measure of premenstrual coping which can be used in future investigations of negative premenstrual experience. A sample of 250 women living in Australia, reporting mild to severe premenstrual distress, completed an online survey containing 64 items related to premenstrual coping. The items were generated by reviewing past literature related to premenstrual experience, in particular recent qualitative research on premenstrual coping. A principal components factor analysis with varimax rotation was conducted to determine item clusters that would form a measure. Reliability and validity were tested using calculations of Cronbach alphas, correlational analysis with psychological coping scales and a content analysis of participant reports of coping strategies. The factor analysis, which involved two principal component analyses, resulted in five factors containing 32 premenstrual coping behaviours. Interpretation of the factor solution drew on empirical and theoretical accounts of premenstrual coping and the emergent factors were labelled Avoiding Harm, Awareness and Acceptance of Premenstrual Change, Adjusting Energy, Self-Care, and Communicating. These factors form the subscales of thePremenstrual Coping Measure (PMCM). The subscales demonstrated acceptable to very good reliability and tests of construct, concurrent and content validity were supportive of sound validity. The PMCM provides a valid and reliable scale for quantifying ways of coping specific to negative premenstrual change. Conceptual similarity was found between some coping behaviours and behaviours positioned as symptoms of premenstrual change. Explanations for this overlap may be found in cultural discourses associated with idealised femininity and PMS (premenstrual syndrome). Further psychometric investigation of the PMCM will enhance knowledge of the role of coping with negative premenstrual experience.
    Full-text · Article · Jan 2014 · BMC Women's Health
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    • "Page 6 of 29 Asia - Pacific Psychiatry 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 F o r R e v i e w O n l y 6 Steiner et al . , 2006"
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    ABSTRACT: Introduction: The aims of the study were to examine the prevalence of premenstrual dysphoric disorder (PMDD), subthreshold PMDD and premenstrual syndrome (PMS) among adolescents, and to assess the nature of symptoms and the impact on daily life functions, especially for PMDD and subthreshold PMDD. Methods: A cross-sectional survey was conducted among adolescents from urban area. Participants included 984 girls divided into the following four groups, using a premenstrual symptoms screening tool: PMDD, subthreshold PMDD, moderate/severe PMS and no/mild PMS. An Adolescent Mental Problem Questionnaire, Center for Epidemiological Studies-Depression Scale, revised Children's Manifest Anxiety Scale, and a menstrual information questionnaire were also used. Results: Sixty-three (6.76%) of the subjects met the criteria for PMDD and 58 (6.2%) were subthreshold PMDD. The subthreshold PMDD group included 79.3% who met the symptom criteria for PMDD, but their impairment was moderate, and 21.7% who were falling short by the number of symptoms for PMDD diagnosis, though reporting severe impairment. The symptom intensity and frequency of the subthreshold PMDD subjects were similar to those in subjects with PMDD. In these two groups, 69% had moderate to severe physical symptoms. Psychiatric problems, including depression and anxiety, were higher in the PMDD and subthreshold PMDD groups than in the moderate/severe PMS and no/mild PMS group. Conclusions: In total, 20% of adolescents reported suffering from distressing premenstrual symptoms, and girls with PMDD and subthreshold PMDD were very similar in their symptom severity and characteristics. Prospective daily charting is needed to confirm the accurate diagnosis and management of PMDD.
    Full-text · Article · Jan 2013 · Asia-Pacific Psychiatry
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