In a new review, researchers analyzed a variety of therapies currently being used to treat premenstrual dysphoric disorder in order to identify which are the most effective. Their findings are published in the Journal of Psychiatric Practice.
Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome, featuring a combination of emotional and physical symptoms that may lead to significant impairment in the sufferer’s home, work, and social life.
About three to eight percent of premenopausal women suffer from PMDD. Severe PMDD symptoms may also lead to suicidal thoughts; one study found that 15 percent of women with PMDD reported at least one suicide attempt.
“Given the debilitating symptoms and impact associated with PMDD, health care professionals need to be able to identify and effectively treat patients with PMDD,” write Shalini Maharaj, M.P.A.S., and Kenneth Trevino, Ph.D., of the University of Texas Southwestern Medical Center.
As an aid to clinical decision making, they conducted an in-depth review of the safety and efficacy of proposed treatments for PMDD.
In their review, the researchers identify a wide range of proposed PMDD treatments, classified as psychiatric, anovulatory, supplements, herbal, and non-pharmacologic.
While the cause of PMDD is not entirely understood, one contributing factor seems to be negative effects of changing hormone levels on certain neurotransmitters, including serotonin.
This has been supported by studies showing a rapid response to selective serotonin reuptake inhibitors (SSRIs), a widely used class of antidepressant drugs. Based on the findings of 31 randomized trials including nearly 4,400 women, SSRIs are considered the “first-line” treatment for PMDD.
Treatment with SSRIs may be continuous, semi-intermittent, or administered at the start of symptoms, but further research is needed to determine which of these treatment schedules provides the best balance between effectiveness and side effects.
For women who do not respond well to SSRIs, other treatment options should be considered. Different types of antidepressants are useful in treating PMDD, while some anti-anxiety drugs are helpful for managing specific PMDD-related symptoms.
They also found that oral contraceptives containing drosperinone/ethinyl estradiol are an effective and recommended treatment option for women with PMDD who are also seeking contraception.
When these options fail, however, various anovulatory treatments — which decrease ovarian hormone production resulting in a state of medical menopause — are effective. However, because of potential side effects and high cost, these are considered “third-line” alternatives.
A variety of potential supplements and herbal-related treatments have been proposed as well, with some warranting further research. However, so far, only calcium supplementation has shown a consistent therapeutic benefit.
The researchers say that larger, placebo-controlled studies are still needed to confirm the best treatments for PMDD. Such studies should use a consistent definition for PMDD and a placebo screening period to confirm the diagnosis.
Source: Wolters Kluwer Health