Selective serotonin reuptake inhibitors (SSRIs) for PMS and PMDD

Examples

Generic Name	Brand Name
citalopram	Celexa
fluoxetine hydrochloride	Prozac, Sarafem
fluvoxamine	Luvox
paroxetine hydrochloride	Paxil, Paxil CR (controlled release)
sertraline hydrochloride	Zoloft

You can take a selective serotonin reuptake inhibitor (SSRI) by mouth every day of the month. Or, you can take an SSRI daily between the day you ovulate and the start of your period (usually about 2 weeks).¹

If you are trying to get pregnant, talk to your doctor about whether an SSRI is safe.

How It Works

An SSRI affects the brain's use of a chemical messenger (neurotransmitter) called serotonin. This improvement in serotonin use is known to be connected to and to improve physical and emotional PMS symptoms, depression, anxiety, hot flashes, and chronic pain.

Why It Is Used

SSRIs are often the first-choice medication for treating severe premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) symptoms, including depression, anxiety, irritability, anger, mood swings, breast tenderness, bloating, headache, and joint and muscle pain.

For many women, SSRI medication need only be taken during the premenstrual phase, generally 2 weeks before the start of menstrual bleeding.

How Well It Works

Research shows SSRIs are very effective in relieving the emotional and physical PMS and PMDD symptoms for most women. SSRI therapy usually brings relief within a few days of starting medication.^{2, 3}

Taking an SSRI only during the premenstrual phase appears to be as effective as continuous SSRI treatment.¹

Side Effects

Side 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.⁴ Some side effects will tend to improve over several weeks. SSRI side effects can include:

• Nausea, appetite changes, weight loss.
• Headache.
• Insomnia, fatigue.
• Nervousness.
• Difficulty with sexual desire, arousal, or orgasm.
• Dizziness.
• Tremors.
• Dry mouth.
• Rash (rare).
• Weight gain (rare) with long-term use.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

Advisories. Health Canada and the U.S. Food and Drug Administration (FDA) have issued:

• Advisories on antidepressant medicines and the risk of suicide. Health Canada and the FDA do 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.
• Warnings 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.
• 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.

What To Think About

When considering SSRI treatment, compare possible SSRI benefits and effectiveness with possible side effects and costs of treatment. You can discuss this with your health professional.

SSRI treatment is not recommended if you have a seizure disorder or a history of mania (including bipolar disorder). These conditions can be made worse by an SSRI.

As with any medication, some medications can adversely interact with an SSRI. Discuss your medication and dietary supplement use with your health professional before trying an SSRI.

When taking an SSRI continuously, never stop taking it abruptly. The long-term use of an SSRI should be tapered off slowly and only under the supervision of a health professional. Abruptly stopping SSRI medications can cause flu-like symptoms, headaches, nervousness, anxiety, or insomnia.

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Author:	Kathe Gallagher, MSW Carrie Henley	Last Updated: August 25, 2006
Medical Review:	Renée M. Crichlow, MD - Family Medicine Adam Husney, MD - Family Medicine Deborah A. Penava, BA, MD, FRCSC, MPH - Obstetrics and Gynecology
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