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Antidepressants are sometimes used for premenstrual syndrome (PMS), but a woman's specific symptoms may predict whether the medications will help, a new study suggests.
Of 447 women in clinical trials testing sertraline (Zoloft) for PMS, those with mixed symptoms – multiple physical and psychological symptoms – were the most likely to see an improvement.
In contrast, women with mainly physical PMS symptoms got little help, unless they had severe bloating or breast tenderness.
Often, diet changes, exercise and over-the-counter painkillers are enough to manage PMS symptoms. But for some, PMS is severe enough to disrupt their daily lives. Studies have found that selective serotonin reuptake inhibitors (SSRIs) can help some women with PMS or premenstrual dysphonic disorder (PMDD).
SSRIs not approved for PMS
But about 40% of women who try an SSRI do not see a benefit.
There's an enormous range of PMS symptoms, and an enormous range in how severe they are, said Dr Ellen W. Freeman, a research professor of obstetrics and gynecology at the University of Pennsylvania in Philadelphia who led the new study.
These findings, she told Reuters Health, suggest that women whose symptoms are primarily physical are unlikely to get much help from an SSRI.
Besides sertraline, other SSRIs approved for treating PMDD include fluoxetine (Sarafem) and paroxetine (Paxil). (Sarafem is a repackaged form of Prozac, marketed specifically for PMDD.)
No SSRI is approved for treating PMS, said Dr Freeman, who has received funding from antidepressant manufacturers. But clinical trials have included not only women with PMDD, but more severe PMS symptoms as well.
Positive results with antidepressants
The current findings, published this month in Obstetrics & Gynaecology, are based on data from three of those clinical trials.
The 447 women with PMS or PMDD were randomly assigned to take either sertraline or placebo. Most had the mixed subtype of PMS or PMDD.
And it turned out that those women stood the greatest chance of benefiting from the antidepressant, Dr Freeman's team found. Almost two-thirds reported a 50% improvement in their symptoms over three menstrual cycles, compared to 42% of the women in the placebo group.
Women with mixed symptoms essentially had the most severe PMS, because they had the greatest number of significant symptoms, Dr Freeman said.
Sertraline less effective
On the other hand, sertraline was less effective for women with primarily physical symptoms (which included 29% of the PMS group and only one woman in the PMDD group).
Of those women, just over half of those on the antidepressant had a 50% drop in their symptoms, versus 38% of women in the placebo group – a statistically no significant difference.
Focusing on specific symptoms, the researchers found that all psychological symptoms were more likely to improve with the antidepressant.
But most physical symptoms – including headache, fatigue, cramps and body aches – did not get better. The exceptions were severe breast tenderness and bloating.
The physical symptoms seemed to truly not respond, unless they were severe breast tenderness or bloating, Dr Freeman said.
Birth control pills an option for PMS
If the symptoms are predominately physical, it seems unlikely that an SSRI will help, Dr Freeman noted.
Since the study looked only at sertraline, it's not possible to say for sure whether the findings would hold true for other SSRIs. But that's likely to be the case, Dr Freeman said.
As with any medication, she added, a woman has to balance the likelihood of benefit with an SSRI against the risks of side effects.
Potential side effects of the medications include headache, nausea, sleep problems and sexual side effects. The drugs have also been linked to an increased risk of suicidal behaviour in teenagers and young adults.
Birth control pills are another option for treating more-severe PMS symptoms. Dr. Freeman said future studies should see whether women with different symptom types respond differently to the Pill as well.
(Reuters Health, December 2011)
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