Premenstrual Dysphoric Disorder Medication

  • Author: Thwe T Htay, MD; Chief Editor: Iqbal Ahmed, MBBS, FRCPsych (UK)   more...
 
Updated: May 14, 2012
 

Medication Summary

The goal of pharmacotherapy is to relieve symptoms. Agents used in the management of premenstrual dysphoric disorder (PMDD) include vitamins and minerals, diuretics, nonsteroidal anti-inflammatory drugs (NSAIDs), antidepressants, beta-blockers, anxiolytics, and contraceptives.

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Nutritionals, Other

Class Summary

Vitamins and minerals have been used for PMDD with varying success rates, as described in the literature.

Pyridoxine; vitamin B-6 (Aminoxin, Pyri-500)

 

Pyridoxine is involved in the synthesis of gamma-aminobutyric acid (GABA) within the central nervous system (CNS).

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Calcium carbonate (Caltrate 600, TUMS, Oysco 500, Rolaids Extra Strength)

 

Calcium supplementation during the luteal phase has proven beneficial with regard to bloating, pain, mood, and food cravings.

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Androgens

Class Summary

The ability of the androgens to inhibit luteinizing hormone (LH) and follicle-stimulating hormone (FSH) release may have a positive effect in the treatment of PMDD.

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Danazol

 

Danazol is a synthetic steroid analogue with strong antigonadotropic activity (ie, inhibition of LH and FSH) and weak androgenic action.

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Aldosterone Antagonists, Selective

Class Summary

Diuretics are widely used for PMDD, on the assumption that many symptoms are secondary to fluid retention.

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Spironolactone (Aldactone)

 

Spironolactone competes with aldosterone for receptor sites in distal renal tubules, increasing water excretion while retaining potassium and hydrogen ions.

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Metolazone (Zaroxolyn)

 

Metolazone is a thiazide diuretic with a reported beneficial effect in PMDD. It increases excretion of sodium, water, potassium, and hydrogen ions by inhibiting reabsorption of sodium in distal tubules.

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Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Class Summary

NSAIDs are reported to improve some physical and mental symptoms in PMDD.

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Naproxen (Aleve, Naprelan, Naprosyn)

 

Naproxen is reported to improve mood changes and headache in PMDD.

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Mefenamic acid (Ponstel)

 

Mefenamic acid is reported to improve premenstrual symptoms, except breast pain.

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Antidepressants, Other

Class Summary

Antidepressants are reported to have positive effects on 1 or more symptoms of PMDD as compared with placebo. Antidepressant therapy is indicated if PMDD symptoms of depression are moderate to severe.

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Bupropion (Wellbutrin, Aplenzin)

 

Bupropion inhibits neuronal dopamine reuptake, in addition to being a weak blocker of serotonin and norepinephrine reuptake.

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Clomipramine (Anafranil)

 

Clomipramine affects serotonin uptake. When converted into its metabolite, desmethyl clomipramine, it affects norepinephrine uptake.

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Nortriptyline (Pamelor)

 

Nortriptyline inhibits reuptake of serotonin, norepinephrine, or both by the presynaptic neuronal membrane.

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Fluoxetine (Sarafem, Prozac)

 

Fluoxetine selectively inhibits presynaptic serotonin reuptake, with minimal or no effect on reuptake of norepinephrine or dopamine.

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Sertraline (Zoloft)

 

Sertraline selectively inhibits presynaptic serotonin reuptake.

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Paroxetine (Paxil, Pexeva)

 

Paroxetine selectively inhibits presynaptic serotonin reuptake. It is reported to have positive effects on 1 or more symptoms of PMDD as compared with placebo.

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Beta-Blockers, Beta-1 Selective

Class Summary

A double-blinded study found the beta-adrenergic blocking agent atenolol to improve irritability. However, a placebo-controlled study of prospectively diagnosed patients found no improvement with atenolol.

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Atenolol (Tenormin)

 

Atenolol selectively blocks beta1 receptors, with little or no effect on beta2 types.

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Antianxiety Agents

Class Summary

Anxiolytics are reported to have positive effects on 1 or more symptoms of PMDD as compared with placebo. They should be used in the management of PMDD if anxiety is the prominent symptom, with dysphoria occurring secondarily.

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Alprazolam (Xanax, Niravam)

 

Alprazolam reduces depression, irritability, and anxiety in PMDD.

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Buspirone

 

Buspirone is a serotonin agonist with serotonergic neurotransmission and some dopaminergic effects in the CNS.

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Estrogens/Progestins

Class Summary

Contraceptives reduce secretion of LH and FSH from the pituitary by decreasing the amount of gonadotropin-releasing hormone (GnRH).

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Ethinyl estradiol and drospirenone (YAZ, Zarah, Ocella, Loryna, Gianvi)

 

This formulation is an oral contraceptive containing ethinyl estradiol 20 µg and drospirenone 3 mg. It is indicated for PMDD in women who choose to use an oral contraceptive as their method of contraception.

Norethindrone acetate/ethinylestradiol (Ortho-Novum, Nortrel, Cyclafem)

 

Norethindrone acetate and ethinyl estradiol are used as an oral contraceptive. The formula is used in women who choose to use an oral contraceptive as their method of contraception.

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Contributor Information and Disclosures
Author

Thwe T Htay, MD  Assistant Professor, Department of Medicine, University of Texas Health Science Center at San Antonio

Thwe T Htay, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

KoKo Aung, MD, MPH, FACP  Associate Professor, Department of Medicine, University of Texas Health Science Center at San Antonio; Adjunct Associate Professor of Public Health, University of Texas School of Public Health

KoKo Aung, MD, MPH, FACP is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Chief Editor

Iqbal Ahmed, MBBS, FRCPsych (UK)  Faculty, Department of Psychiatry, Tripler Army Medical Center; Clinical Professor of Psychiatry, Uniformed Services University of Health Sciences: Clinical Professor of Psychiatry, Clinical Professor of Geriatric Medicine, University of Hawaii, John A Burns School of Medicine

Iqbal Ahmed, MBBS, FRCPsych (UK) is a member of the following medical societies: Academy of Psychosomatic Medicine, American Association for Geriatric Psychiatry, American Neuropsychiatric Association, American Psychiatric Association, American Society of Clinical Psychopharmacology, and Royal College of Psychiatrists

Disclosure: Nothing to disclose.

Additional Contributors

Ronald C Albucher, MD Chief Medical Officer, Westside Community Services; Consulting Staff, California Pacific Medical Center

Ronald C Albucher, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: Nothing to disclose.

John Carrick, MD Consulting Staff, Department of Psychiatry, Flagstaff Medical Center

John Carrick, MD is a member of the following medical societies: American Association for Geriatric Psychiatry

Disclosure: Nothing to disclose.

Romeo Papica II MD Staff Physician, Premier Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References

  1. Endicott J. History, evolution, and diagnosis of premenstrual dysphoric disorder. J Clin Psychiatry. 2000;61 Suppl 12:5-8. [Medline].

  2. Frank RT. The hormonal causes of premenstrual tension. Arch Neurol Psych. 1931;26:1053-57.

  3. Dell DL. Premenstrual Syndrome, Premenstrual Dysphoric Disorder, and Premenstrual Exacerbation of Another Disorder. Clin Obstet Gynecol. Sep 2004;47(3):568-575. [Medline].

  4. Klock SC. Premenstrual dysphoric disorder. In: Ryan KJ, ed. Kistner's Gynecology and Women's Health. 7th ed. 520-4.

  5. Steiner M, Pearlstein T. Premenstrual dysphoria and the serotonin system: pathophysiology and treatment. J Clin Psychiatry. 2000;61 Suppl 12:17-21. [Medline].

  6. Mueller EA, Murphy DL, Sunderland T. Neuroendocrine effects of M-chlorophenylpiperazine, a serotonin agonist, in humans. J Clin Endocrinol Metab. Dec 1985;61(6):1179-84. [Medline].

  7. Ling FW. Recognizing and treating premenstrual dysphoric disorder in the obstetric, gynecologic, and primary care practices. J Clin Psychiatry. 2000;61 Suppl 12:9-16. [Medline].

  8. Boyle CA, Berkowitz GS, Kelsey JL. Epidemiology of premenstrual symptoms. Am J Public Health. Mar 1987;77(3):349-50. [Medline].

  9. Grady-Weliky TA. Clinical practice. Premenstrual dysphoric disorder. N Engl J Med. Jan 30 2003;348(5):433-8. [Medline].

  10. Banerjee N, Roy KK, Takkar D. Premenstrual dysphoric disorder--a study from India. Int J Fertil Womens Med. Sep-Oct 2000;45(5):342-4. [Medline].

  11. Tschudin S, Bertea PC, Zemp E. Prevalence and predictors of premenstrual syndrome and premenstrual dysphoric disorder in a population-based sample. Arch Womens Ment Health. Dec 2010;13(6):485-94. [Medline].

  12. Issa BA, Yussuf AD, Olatinwo AW, Ighodalo M. Premenstrual dysphoric disorder among medical students of a Nigerian university. Ann Afr Med. Jul-Sep 2010;9(3):118-22. [Medline].

  13. Stout AL, Grady TA, Steege JF, et al. Premenstrual symptoms in black and white community samples. Am J Psychiatry. Nov 1986;143(11):1436-9. [Medline].

  14. Woods NF, Most A, Dery GK. Prevalene of perimenstrual symptoms. Am J Public Health. Nov 1982;72(11):1257-64. [Medline].

  15. Chang AM, Holroyd E, Chau JP. Premenstrual syndrome in employed Chinese women in Hong Kong. Health Care Women Int. Nov-Dec 1995;16(6):551-61. [Medline].

  16. The American Psychiatric Association. Diagnostic and statistical manual of mental disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association; 2000:717-8.

  17. Bhatia SC, Bhatia SK. Depression in women: diagnostic and treatment considerations. Am Fam Physician. Jul 1999;60(1):225-34, 239-40. [Medline].

  18. Baca-Garcia E, Diaz-Sastre C, Ceverino A, García Resa E, Oquendo MA, Saiz-Ruiz J, et al. Premenstrual symptoms and luteal suicide attempts. Eur Arch Psychiatry Clin Neurosci. Oct 2004;254(5):326-9. [Medline].

  19. Kim SY, Park HJ, Lee H, Lee H. Acupuncture for premenstrual syndrome: a systematic review and meta-analysis of randomised controlled trials. BJOG. Jul 2011;118(8):899-915. [Medline].

  20. Goodale IL, Domar AD, Benson H. Alleviation of premenstrual syndrome symptoms with the relaxation response. Obstet Gynecol. Apr 1990;75(4):649-55. [Medline].

  21. Lam RW, Carter D, Misri S, et al. A controlled study of light therapy in women with late luteal phase dysphoric disorder. Psychiatry Res. Jun 30 1999;86(3):185-92. [Medline].

  22. Krasnik C, Montori VM, Guyatt GH, Heels-Ansdell D, Busse JW. The effect of bright light therapy on depression associated with premenstrual dysphoric disorder. Am J Obstet Gynecol. Sep 2005;193(3 Pt 1):658-61. [Medline].

  23. Parry BL, Cover H, Mostofi N, et al. Early versus late partial sleep deprivation in patients with premenstrual dysphoric disorder and normal comparison subjects. Am J Psychiatry. Mar 1995;152(3):404-12. [Medline].

  24. Blake F, Salkovskis P, Gath D, et al. Cognitive therapy for premenstrual syndrome: a controlled trial. J Psychosom Res. Oct 1998;45(4):307-18. [Medline].

  25. Busse JW, Montori VM, Krasnik C, Patelis-Siotis I, Guyatt GH. Psychological intervention for premenstrual syndrome: a meta-analysis of randomized controlled trials. Psychother Psychosom. 2009;78(1):6-15. [Medline].

  26. Lustyk MK, Gerrish WG, Shaver S, Keys SL. Cognitive-behavioral therapy for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review. Arch Womens Ment Health. Apr 2009;12(2):85-96. [Medline].

  27. drospirenone and ethinyl estradiol (YAZ®) [package insert]. Wayne, NJ: Bayer Health Care Phamaceuticals; 2007. [Full Text].

  28. Wyatt K, Dimmock P, O'Brien PMS. Premenstrual syndrome. Clin Evid. 2000;4:1121-33.

  29. Pearlstein T, Steiner M. Non-antidepressant treatment of premenstrual syndrome. J Clin Psychiatry. 2000;61 Suppl 12:22-7. [Medline].

  30. Andersen AN, Larsen JF, Steenstrup OR, Svendstrup B, Nielsen J. Effect of bromocriptine on the premenstrual syndrome. A double-blind clinical trial. Br J Obstet Gynaecol. May 1977;84(5):370-4. [Medline].

  31. Kullander S, Svanberg L. Bromocriptine treatment of the premenstrual syndrome. Acta Obstet Gynecol Scand. 1979;58(4):375-8. [Medline].

  32. Graham JJ, Harding PE, Wise PH, Berriman H. Prolactin suppression in the treatment of premenstrual syndrome. Med J Aust. Nov 4 1978;2(3 Suppl):18-20. [Medline].

  33. Werch A, Kane RE. Treatment of premenstrual tension with metolazone: a double-blind evaluation of a new diuretic. Curr Ther Res Clin Exp. Jun 1976;19(6):565-72. [Medline].

  34. Rickels K, Freeman E, Sondheimer S. Buspirone in treatment of premenstrual syndrome. Lancet. Apr 8 1989;1(8641):777. [Medline].

  35. Harrison WM, Endicott J, Nee J. Treatment of premenstrual dysphoria with alprazolam. A controlled study. Arch Gen Psychiatry. Mar 1990;47(3):270-5. [Medline].

  36. Schmidt PJ, Grover GN, Rubinow DR. Alprazolam in the treatment of premenstrual syndrome. A double-blind, placebo-controlled trial. Arch Gen Psychiatry. Jun 1993;50(6):467-73. [Medline].

  37. Eriksson E. Serotonin reuptake inhibitors for the treatment of premenstrual dysphoria. Int Clin Psychopharmacol. May 1999;14 Suppl 2:S27-33. [Medline].

  38. The Medical Letter. Which SSRI?. Med Lett Drugs Ther. Nov 24 2003;45(1170):93-5. [Medline].

  39. Steiner M. Recognition of premenstrual dysphoric disorder and its treatment. Lancet. Sep 30 2000;356(9236):1126-7. [Medline].

  40. Brown J, O' Brien PM, Marjoribanks J, Wyatt K. Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database Syst Rev. Apr 15 2009;CD001396. [Medline].

  41. Steiner M, Steinberg S, Stewart D, et al. Fluoxetine in the treatment of premenstrual dysphoria. Canadian Fluoxetine/Premenstrual Dysphoria Collaborative Study Group. N Engl J Med. Jun 8 1995;332(23):1529-34. [Medline].

  42. The Medical Letter. Fluoxetine (Sarafem) for premenstrual dysphoric disorder. Med Lett Drugs Ther. Jan 22 2001;43(1096):5-6. [Medline].

  43. Yonkers KA, Halbreich U, Freeman E, et al. Symptomatic improvement of premenstrual dysphoric disorder with sertraline treatment. A randomized controlled trial. Sertraline Premenstrual Dysphoric Collaborative Study Group. JAMA. Sep 24 1997;278(12):983-8. [Medline].

  44. Young SA, Hurt PH, Benedek DM, Howard RS. Treatment of premenstrual dysphoric disorder with sertraline during the luteal phase: a randomized, double-blind, placebo-controlled crossover trial. J Clin Psychiatry. Feb 1998;59(2):76-80. [Medline].

  45. Steiner M, Hirschberg AL, Bergeron R, et al. Luteal phase dosing with paroxetine controlled release (CR) in the treatment of premenstrual dysphoric disorder. Am J Obstet Gynecol. 2005;193:352-60. [Medline].

  46. Steiner M, Ravindran AV, LeMelledo JM, Carter D, Huang JO, Anonychuk AM, et al. Luteal phase administration of paroxetine for the treatment of premenstrual dysphoric disorder: a randomized, double-blind, placebo-controlled trial in Canadian women. J Clin Psychiatry. Jun 2008;69(6):991-8. [Medline].

  47. Freeman EW, Rickels K, Sondheimer SJ, et al. Nefazodone in the treatment of premenstrual syndrome: a preliminary study. J Clin Psychopharmacol. Jun 1994;14(3):180-6. [Medline].

  48. Freeman EW, Rickels K, Yonkers KA, et al. Venlafaxine in the treatment of premenstrual dysphoric disorder. Obstet Gynecol. Nov 2001;98(5 Pt 1):737-44. [Medline].

  49. Freeman EW, Sondheimer SJ, Sammel MD, et al. A preliminary study of luteal phase versus symptom-onset dosing with escitalopram for premenstrual dysphoric disorder. J Clin Psychiatry. 2005;66:769-73. [Medline].

  50. Shah NR, Jones JB, Aperi J, Shemtov R, Karne A, Borenstein J. Selective serotonin reuptake inhibitors for premenstrual syndrome and premenstrual dysphoric disorder: a meta-analysis. Obstet Gynecol. May 2008;111(5):1175-82. [Medline].

  51. Kayatekin ZE, Sabo AN, Halbreich U. Levetiracetam for treatment of premenstrual dysphoric disorder: a pilot, open-label study. Arch Womens Ment Health. Jul 2008;11(3):207-11. [Medline].

  52. Wyatt KM, Dimmock PW, Jones PW, Shaughn O'Brien PM. Efficacy of vitamin B-6 in the treatment of premenstrual syndrome: systematic review. BMJ. May 22 1999;318(7195):1375-81. [Medline].

  53. Thys-Jacobs S, Starkey P, Bernstein D, Tian J. Calcium carbonate and the premenstrual syndrome: effects on premenstrual and menstrual symptoms. Premenstrual Syndrome Study Group. Am J Obstet Gynecol. Aug 1998;179(2):444-52. [Medline].

  54. Facchinetti F, Borella P, Sances G, Fioroni L, Nappi RE, Genazzani AR. Oral magnesium successfully relieves premenstrual mood changes. Obstet Gynecol. Aug 1991;78(2):177-81. [Medline].

  55. Walker AF, De Souza MC, Vickers MF, Abeyasekera S, Collins ML, Trinca LA. Magnesium supplementation alleviates premenstrual symptoms of fluid retention. J Womens Health. Nov 1998;7(9):1157-65. [Medline].

  56. Budeiri D, Li Wan Po A, Dornan JC. Is evening primrose oil of value in the treatment of premenstrual syndrome?. Control Clin Trials. Feb 1996;17(1):60-8. [Medline].

 
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