What is premenstrual syndrome?
For as long as you
menstrual cycle and
ovulate, your hormone-producing
endocrine system has powerful, cyclic effects on your
body. While some women barely notice these effects, up to 80% of women normally
have one or more premenstrual symptoms. These happen between the time you
ovulate and the first days of your menstrual period.3
When premenstrual physical and emotional symptoms interfere with your
relationships or responsibilities, they are called
premenstrual syndrome (PMS). When these emotional
symptoms or aggression become severe, it is called
premenstrual dysphoric disorder (PMDD). In contrast to
PMS, PMDD affects up to 8% of women.4
Because a woman's endocrine system is so complex, there are a number of
possible hormones and other chemicals in the body that can trigger PMS
symptoms. Serotonin is the best-known
neurotransmitter chemical that impacts symptoms in
many women with PMS. For many women, improving the brain's use of serotonin
helps relieve a number of emotional and physical PMS symptoms.
What are selective serotonin reuptake inhibitors (SSRIs)?
SSRIs are a class of medicine that affects the brain's
use of the neurotransmitter serotonin. This improvement in serotonin use is
known to improve physical and emotional PMS symptoms. SSRIs are also used to
hot flashes, and
SSRIs are usually the
first-choice medicine for treating severe PMS and PMDD symptoms, including
depression, anxiety, irritability, anger, mood swings, breast tenderness,
bloating, headache, and joint and muscle pain. SSRI treatment only during the
premenstrual phase appears to be as effective as continuous SSRI
treatment.1 And it costs less. If you have PMS
symptoms that completely go away during your period, this approach is likely to
work for you. But if you have emotional symptoms of depression or anxiety all
of the time, taking an SSRI continuously may be a better option for you.
Commonly used SSRIs for PMS include sertraline (Zoloft),
fluoxetine (Prozac, Sarafem), paroxetine (Paxil), fluvoxamine (Luvox), and
citalopram (Celexa). They each have slightly different effects on mood. While
one SSRI may not be right for you, another SSRI may work well. SSRI therapy for
PMS usually brings relief within a few days of starting the medicine but can
What are the side effects of SSRI treatment?
effects from SSRI treatment are usually not serious. But these side effects are
fairly common, and they are why some people stop taking SSRI medicine.5 Some side effects will tend to subside over several weeks.
Among women taking an SSRI for PMS, several side effects have been widely
- Nausea, appetite changes, weight loss.
- Insomnia, fatigue.
- Difficulty with sexual desire, arousal,
- Rash (rare).
- Weight gain (rare), with long-term
FDA Advisories. The U.S. Food
and Drug Administration (FDA) has issued:
advisory on antidepressant medicines and the risk of
suicide. The FDA does not recommend that people stop using these medicines.
Instead, a person taking an SSRI should be watched for any
warning signs of suicide. This is especially important
at the beginning of treatment or when doses are changed.
warning about the antidepressants Paxil and Paxil CR
and birth defects. Taking these medicines in the first 12 weeks of pregnancy
may increase your chance of having a baby with a birth defect.2
- A warning about taking triptans, used for headaches, with SSRIs
(selective serotonin reuptake inhibitors) or SNRIs (selective
serotonin/norepinephrine reuptake inhibitors). Taking these medicines together
can cause a very rare but serious condition called serotonin syndrome.