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In women who suffer from a severe form of PMS known as premenstrual dysphoric disorder (PMDD), taking the antidepressant Paxil only when symptoms are at a peak significantly curbs irritability and improves social functioning, according to a study of Canadian women.

PMDD is a condition characterized by symptoms of severe depression, irritability and tension, which often occur during the “luteal phase” of the menstrual cycle - the part of a woman’s menstrual cycle from ovulation to the start of the next period.

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[...]I have learned that severe PMS (now called premenstrual dysphoric disorder or PMDD) has a biological basis. We know hormones have effects on neurotransmitters (chemical messengers in the brain) like serotonin and noradrenalin, and a variety of serotonin abnormalities have been found throughout the menstrual cycle in women with PMS. Antidepressants that affect serotonin, like Prozac and Zoloft (SSRIs), have been effective for more than 70 percent of women with PMDD. Newer strategies that use these medications during only part of the menstrual cycle are now being employed for some women.

When antidepressants are used to treat depression, it may take three or four weeks before they are effective. Many antidepressants don’t work for women or simply stop working, i.e. “prozac poop out”. In PMDD the positive effect is almost immediate. This means some women can take the medication starting a day or two before their symptoms typically begin and stop it once menstruation has begun.

What about hormonal treatments for PMS? Medications like leuprolide that turn off ovulation are effective but have more side effects and carry the potential for long-term risks like osteoporosis. Progesterone and oral contraceptives had been widely used for PMS, but many studies have now shown high dose estrogen and progestin contraceptives are not effective. In fact, some studies have demonstrated these oral contraceptives worsened depressive symptoms in some women.[...]

In their study, Dr. Meir Steiner with St. Joseph’s Healthcare, Hamilton, Ontario and colleagues had a group of women suffering from PMDD rate their premenstrual symptoms each day for two consecutive menstrual cycles.

Women found to have the symptoms of irritability and/or depressed mood only in the luteal phase were randomly assigned to take paroxetine (10 or 20 milligrams) or placebo only during this time period for four additional menstrual cycles.

When compared with placebo, women treated with the higher dose of paroxetine experienced “significant improvements in the psychological symptoms associated with PMDD such as irritability, depressed mood, and tension,” the investigators report.

Women treated with paroxetine 20 milligrams also experienced improvement in social and family life functioning.

These findings, the researchers note, are consistent with findings from previous studies suggesting that PMDD may be treated effectively by intermittent-only administration of paroxetine.

The findings, Steiner and colleagues add, support recently published expert guidelines for the treatment of PMDD, which state that an intermittent dosing schedule is an appropriate choice for women who wish to limit the amount of medication they take, can adhere to the on/off dosing regimen, have no mood symptoms at other times during the menstrual cycle, or are concerned about long-term side effects of antidepressant medication.

SOURCE: Journal of Clinical Psychiatry.