Low-Dose Sertraline in the Treatment of Moderate-to-Severe Premenstrual Syndrome

[Argirios Argiriou]

Low-Dose Sertraline in the Treatment of Moderate-to-Severe Premenstrual Syndrome: Efficacy of 3 Dosing Strategies
Susan G. Kornstein, M.D.; Teri B. Pearlstein, M.D.; Rana Fayyad, Ph.D.; Gail M. Farfel, Ph.D.; and John A. Gillespie, M.D.
J Clin Psychiatry 2006;67:1624-1632

Objective: Many studies have demonstrated the efficacy of selective serotonin reuptake inhibitors (SSRIs) in the treatment of premenstrual dysphoric disorder, but few studies have investigated the efficacy of SSRIs in the treatment of premenstrual syndrome (PMS). The objective of this study was to evaluate the safety and efficacy of sertraline in the treatment of moderate-to-severe PMS using 3 different dosing strategies: luteal phase (2 cycles), followed by continuous dosing throughout the month (1 cycle), followed by dosing begun at the first onset of PMS symptoms, or "symptom-onset" dosing (1 cycle).

Method: 314 women with PMS from 22 U.S. sites were randomly assigned to fixed-dose treatment with sertraline (25 or 50 mg/day) or placebo for 4 menstrual cycles after a single-blind, placebo lead-in cycle. Assessments included the Daily Symptom Report (DSR), the Clinical Global Impressions-Severity of Illness and -Improvement scales, the Patient Global Evaluation scale, the Quality of Life Enjoyment and Satisfaction Questionnaire, and the Social Adjustment Scale-Self Report.

Results: Intermittent luteal-phase dosing with low doses of sertraline (25 and 50 mg/day) ( i.e. sertraline taken for two weeks before the onset of the menstrual period ) produced significant improvement across 2 menstrual cycles, based on total DSR scores, compared with placebo. Continuous and symptom-onset dosing were also effective in treating PMS symptoms, particularly at the lower dose of 25 mg/day.

Conclusions: The results of the current study suggest that low doses of sertraline may be a safe, effective, and well-tolerated treatment for moderate-to-severe PMS.



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[Argirios Argiriou]

και η σιταλοπράμη μπορεί να έχει αποτέλεσμα στο PMS:

J Womens Health Gend Based Med. 2002 Jun;11(5):459-64.
Citalopram in PMS patients with prior SSRI treatment failure: a preliminary study.
Freeman EW, Jabara S, Sondheimer SJ, Auletto R.
Source

Departments of Obstetrics/Gynecology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA.
Abstract
OBJECTIVES:

Evidence shows that the selective serotonin reuptake inhibitors (SSRIs) effectively reduce the symptoms of severe premenstrual syndrome (PMS). A placebo-controlled study of citalopram, the most selective SSRI, demonstrated that half-cycle dosing (luteal phase) was effective for DSM-IV-defined premenstrual dysphoric disorder (PMDD), a severe form of PMS. This study examined the effectiveness of half-cycle dosing of citalopram in PMS patients who did not respond to previous SSRI treatment.
METHODS:

Seventeen women with no improvement in symptoms after two menstrual cycles on an SSRI were given open-label citalopram (20-40 mg/day). Eleven subjects received half-cycle dosing, and 6 subjects received full-cycle dosing. Scores on the 17-item daily symptom report (DSR) and on each of five DSR symptom clusters were used to measure citalopram efficacy.
RESULTS:

Total premenstrual DSR scores were significantly improved (p <0.001) in both half-cycle and full-cycle dosing groups. The half-cycle group reported lower DSR scores throughout treatment compared with the full-cycle group, but the difference did not reach statistical significance in this small sample. All DSR factor scores (mood, behavioral, pain, physical symptoms, and appetite) significantly improved. Clinical improvement (>or=50% decrease from baseline DSR) was reported by 76% of the subjects overall. Forty-one percent of the subjects experienced symptom remission, defined as a decrease in symptoms to postmenstrual levels.
CONCLUSIONS:

These results from a small number of subjects with open-label treatment must be viewed as preliminary but suggest that citalopram treatment is effective for PMS patients who failed previous SSRI treatment.

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και

One of the optimum regimes for treatment-resistant PMS is half-cycle citalopram, 20mg/day from day 15 to day 28 of the menstrual cycle. This appears to be effective even in women whose previous SSRI treatment has failed.

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[Argirios Argiriou]

Cochrane Database Syst Rev. 2009 Apr 15;(2):CD001396.
Selective serotonin reuptake inhibitors for premenstrual syndrome.
Brown J, O' Brien PM, Marjoribanks J, Wyatt K.
Source

Obstetrics and Gynaecology, University of Auckland, FMHS, Auckland, New Zealand. j.brown@auckland.ac.nz
Abstract
BACKGROUND:

This is a substantive update of a previous review. Severe premenstrual syndrome (PMS) affects between 3% to 5% of women of reproductive age. Severe PMS is classified under the Diagnostic and Statistical Manual of Mental Disorders as premenstrual dysphoric disorder (PMDD). Selective serotonin reuptake inhibitors (SSRIs) are increasingly used as front-line therapy for PMS. A systematic review was undertaken on the efficacy of SSRIs in the management of severe PMS, or PMDD, to assess the evidence for this treatment option.
OBJECTIVES:

The objective of this review was to evaluate the effectiveness of SSRIs in reducing premenstrual syndrome symptoms in women diagnosed with severe premenstrual syndrome.
SEARCH STRATEGY:

Electronic searches for relevant randomised controlled trials were undertaken in the Cochrane Menstrual Disorders and Subfertility Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, PsycInfo, and CINAHL (March 2008). Where insufficient data were presented in a report the original authors were contacted for further details.
SELECTION CRITERIA:

All trials were considered in which women with a prospective diagnosis of PMS, PMDD or late luteal phase dysphoric disorder (LPDD) were randomised to receive SSRIs or placebo for the treatment of premenstrual syndrome in a blinded trial.
DATA COLLECTION AND ANALYSIS:

Forty randomised controlled trials were identified which reported the use of SSRIs in the management of PMS. Fifty-six trials were excluded. The review authors extracted the data independently and estimated standardised mean differences for continuous outcomes.
MAIN RESULTS:

Due to heterogeneity, analyses were subgrouped into change and absolute scores. The primary analysis of reduction in overall symptomatology included data on 2294 women with premenstrual syndrome. SSRIs were found to be highly effective in treating the premenstrual symptoms (SMD -0.53, 95% CI 0.68 to -0.39; P < 0.00001). Secondary analysis showed that they were effective in treating physical (SMD -0.34, 95% CI -0.45 to -0.22; P < 0.00001), functional (SMD -0.30, 95% CI -0.43 to -0.17; P < 0.00001), and behavioural symptoms (SMD -0.41, 95% CI -0.53 to -0.29; P < 0.00001). Luteal phase only and continuous administration were both effective and there was no influence of a placebo run-in period on reduction in symptoms. All SSRIs (fluoxetine, paroxetine, sertraline, fluvoxamine, citalopram, and clomipramine) were effective in reducing premenstrual symptoms. Withdrawals due to side effects were twice as likely to occur in the treatment group (OR 2.18, 95% CI 1.62 to 2.92; P < 0.00001).
AUTHORS' CONCLUSIONS:

The evidence supports the use of selective serotonin reuptake inhibitors in the management of severe premenstrual syndrome.

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