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Selective Serotonin Reuptake Inhibitors and Initial Oral Contraceptives for the Treatment of PMDD: Effective But Not Enough

Published online by Cambridge University Press:  07 November 2014

Uriel Halbreich
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Abstract

Background:

Selective serotonin reuptake inhibitors (SSRIs) are almost unanimously considered to be very efficacious and the first line of pharmacologic treatment for premenstrual dysphoric disorder (PMDD) and premenstrual syndrome (PMS). There is a need to examine if this is actually the case. More recently, combined oral contraceptives (COCs) have been pursued due to their ovulation suppression effects. Their effects on PMS/PMDD should be further examined as well.

Methods:

For this review of the literature from 1990 to the present, MEDLINE, PsychLit, and Cochrane controlled trials register were searched. Randomized, double-blind, placebo-controlled clinical trials of SSRIs and COCs (N>20) that report the rate of responders and not just percent improvement in severity of symptoms were selected for study. The data extraction were the percentage or number of responders as reported by the original authors.

Results:

In many studies, only mean improvement in severity was reported. In all studies, the main inclusion criterion was meeting criteria for PMDD; this has not, however, been an outcome measure. However, only 16 reports that provided actual rate of responders could be included. The percentage of non-responders (100% minus active medication) to SSRIs and COCs was found to be higher than the reported percentage of women who responded to active medication (response rate to an SSRI or COC minus the response rate to placebo).

Conclusion:

In the majority of larger-scale studies, once the placebo effect is accounted for, the percentage of women who respond to SSRIs or COCs is actually less than the percentage of women who do not respond at all. SSRIs provide an important step forward in the treatment of PMDD and PMS. COCs provide a different option, still, ~40% of women with PMDD do not respond to SSRIs. Treatment with a currently approved COC does not substantially improve the percentage of responders. Therefore, additional alternative targeted treatment modalities need to be developed.

Type
The Well-Rounded Brain
Information
CNS Spectrums , Volume 13 , Issue 7 , July 2008 , pp. 566 - 572
Copyright
Copyright © Cambridge University Press 2008

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References

REFERENCES

1.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
2.American College of Obstetricians and Gynecologists. Premenstrual Syndrome. ACOG practice bulletin no 15. Washington, DC: American College of Obstetricians and Gynecologists; 2000.Google Scholar
3.Halbreich, U, Bornstein, J, Pearlstein, T, Kahn, LS. The prevalence, impairment, impact and burden of premenstrual dysphoric disorder (PMS, PMDD). Psychoneuroendocrinology. 2003;28(suppl 3):1–23.Google Scholar
4.Wittchen, HU, Becker, E, Lieb, R, Krause, P. Prevalence, incidence and stability of premenstrual dysphoric disorder in the community. Psychol Med. 2002;32:119–132.Google Scholar
5.Halbreich, U. The etiology, biology, and evolving pathology of premenstrual syndromes. Psychoneuroendocrinology. 2003;28(suppl 3):55–99.Google Scholar
6.Rapkin, A. A review of treatment of premenstrual syndrome and premenstrual dysphoric disorder. Psychoneuroendocrinology. 2003;28(suppl 3):39–53.Google Scholar
7.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. 1995;332:1529–1534.Google Scholar
8.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. 1997;278:983–988.Google Scholar
9.Halbreich, U, Bergeron, R, Yonkers, KA, Freeman, E, Stout, AL, Cohen, L. Efficacy of intermittent, luteal phase sertraline treatment of premenstrual dysphoric disorder. Obstet Gynecol. 2002;100:1219–1229.Google ScholarPubMed
10.Freeman, EW, Rickles, K, Yonkers, KA, Kunz, NR, McPherson, MK, Upton, GV. Venlafaxine in the treatment of premenstrual dysphoric disorder. Obstet Gynecol. 2001;98(5 pt 1):737–744.Google Scholar
11.Freeman, EW, Rickels, K, Sondheimer, SJ, Polansky, M. Differential response to antidepressants in women with premenstrual syndrome/premenstrual dysphoric disorder: a randomized controlled trial. Arch Gen Psychiatry. 1999;56:932–939.Google Scholar
12.Wikander, I, Sundblad, C, Andersch, B, et al.Citalopram in premenstrual dysphoria: is intermittent treatment during luteal phases more effective than continuous medication throughout the menstrual cycle? J Clin Psychopharmacol. 1998;18:390–398.Google Scholar
13.Diegoli, MS, da Fonseca, AM, Diegoli, CA, Pinotti, JA. A double-blind trial of four medications to treat severe premenstrual syndrome. Int J Gynaecol Obstet. 1998;62:63–67.Google Scholar
14.Jermain, DM, Preece, CK, Sykes, RL, Kuehl, TJ, Sulak, PJ. Luteal phase sertraline treatment for premenstrual dysphoric disorder. Results of a double-blind, placebo-controlled, crossover study. Arch Fam Med. 1999;8:328–332.Google Scholar
15.Eriksson, E, Hedberg, MA, Andersch, B, Sundblad, C. The serotonin reuptake inhibitor paroxetine is superior to the noradrenaline reuptake inhibitor maprotiline in the treatment of premenstrual syndrome. Neuropsychopharmacology. 1995;12:167–176.Google Scholar
16.Ozeren, S, Corakçi, A, Yücesoy, I, Mercan, R, Erhan, G. Fluoxetine in the treatment of premenstrual syndrome. Eur J Obstet Gynecol Reprod Biol. 1997;73:167–170.Google Scholar
17.Pearlstein, TB, Stone, AB, Lund, SA, Scheft, H, Zlotnick, C, Brown, WA. Comparison of fluoxetine, bupropion, and placebo in the treatment of premenstrual dysphoric disorder. J Clin Psychopharmacol. 1997;17:261–266.Google Scholar
18.Stone, AB, Pearlstein, TB, Brown, WA. Fluoxetine in the treatment of late luteal phase dysphoric disorder. J Clin Psychiatry. 1991;52:290–293.Google Scholar
19.Wood, SH, Mortola, JF, Chan, YF, Moossazadeh, F, Yen, SS. Treatment of premenstrual syndrome with fluoxetine: a double-blind, placebo-controlled, crossover study. Obstet Gynecol. 1992:80(3 pt 1):339–344.Google Scholar
20.Menkes, DB, Taghavi, E, Mason, PA, Howard, RC. Fluoxetine's spectrum of action in premenstrual syndrome. Int Clin Psychopharmacol. 1993;8:95–102.CrossRefGoogle ScholarPubMed
21.Halbreich, U, Smoller, JW. Intermittent luteal phase sertraline treatment of dysphoric premenstrual syndrome. J Clin Psychiatry. 1997;58:399–402.CrossRefGoogle ScholarPubMed
22.Su, TP, Schmidt, PJ, Danaceau, MA, et al.Fluoxetine in the treatment of premenstrual dysphoria. Neuropsychopharmacology. 1997;16:346–356.Google Scholar
23.Young, SA, Hurt, PH, Benedek, DM, et al.Treatment of premenstrual dysphoric disorder with sertraline during the luteal phase: a randomized, double-blind, placebo-controlled crossover trial. J Clin Psychiatry. 1998;59:76–80.Google Scholar
24.Veeninga, AT, Westenber, HG, Weusten, JT. Fluvoxamine in the treatment of menstrually related mood disorders. Psychopharmacology (Berl). 1990;102:414–416.CrossRefGoogle ScholarPubMed
25.Cohen, LS, Miner, C, Brown, E, et al.Premenstrual daily fluoxetine for premenstrual dysphoric disorder: a placebo-controlled, clinical trial using computerized diaries. Obstet Gynecol. 2002;100:435–444.Google Scholar
26.Miner, C, Brown, E, McCray, S, Gonzales, J, Wohlreich, M. Weekly luteal-phase dosing with enteric-coated fluoxetine 90 mg in premenstrual dysphoric disorder: a randomized, double-blind, placebo-controlled clinical trial. Clin Ther. 2002;24:417–433.Google Scholar
27.Dimmock, PW, Wyatt, KM, Jones, PW, O'Brien, PM. Efficacy of selective serotonin-reuptake inhibitors in premenstrual syndrome: a systematic review. Lancet. 2000;356:1131–1136.Google Scholar
28.Pearlstein, T. Selective serotonin reuptake inhibitors for premenstrual dysphoric disorder: the emerging gold standard? Drugs. 2002;62:1869–1885.CrossRefGoogle ScholarPubMed
29.Steiner, M, Hirschberg, AL, Bergeron, R, Holland, F, Gee, MD, Van Erp, E. Luteal phase dosing with paroxetine controlled release (CR) in the treatment of premenstrual dysphoric disorder. Am J Obstet Gynecol. 2005;193:352–360.Google Scholar
30.Cohen, LS, Soares, CN, Yonkers, KA, Bellew, KM, Bridges, IM, Steiner, M. Paroxetine controlled release for premenstrual dysphoric disorder: a double blind, placebo-controlled trial. Psychosom Med. 2004;66:707–713.Google Scholar
31.Pearlstein, TB, Bachmann, GA, Zacur, HA, et al.Treatment of premenstrual dysphoric disorder with a new drospirenone-containing oral contraceptive formulation. Contraception. 2005;72:414–421.Google Scholar
32.Yonkers, KA, Brown, C, Pearlstein, TB, Foegh, M, Sampson-Landers, C, Rapkin, A. Efficacy of a new low-dose oral contraceptive with drospirenone in premenstrual dysphoric disorder. Obstet Gynecol. 2005;106:492–501.Google Scholar
33.Landén, M, Nissbrandt, H, Allgulander, C, Sörvik, K, Ysander, C, Eriksson, E. Placebo-controlled trial comparing intermittent and continuous paroxetine in premenstrual dysphoric disorder. Neuropsychopharmacology. 2007;32:153–161.Google Scholar