Selective Serotonin Reuptake Inhibitors (SSRIs) for PMS and PMDD

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Selective Serotonin Reuptake Inhibitors (SSRIs) for PMS and PMDD

Examples

Generic NameBrand Name
citalopramCelexa
fluoxetineProzac
fluvoxamineLuvox
paroxetinePaxil
sertralineZoloft

How It Works

SSRIs are a type of medicine that can restore the balance of certain brain chemicals called neurotransmitters. This may help relieve physical and emotional symptoms of PMS. SSRIs are also used to treat depression, anxiety, menopause hot flashes, and chronic pain.

Why It Is Used

SSRIs are often the first-choice medicine 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 medicine need only be taken during the premenstrual phase, generally 2 weeks before the start of menstrual bleeding.

How Well It Works

SSRIs may help relieve the emotional and physical PMS and PMDD symptoms.1 SSRI therapy can bring relief within a few days of starting this medicine.

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. 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:

  • An advisory on antidepressant medicines and the risk of suicide. It does not recommend that people stop using these medicines. Instead, a person taking an antidepressant should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when doses are changed.
  • A warning about the antidepressants Paxil and Paxil CR (paroxetine) 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

Pregnancy. If you are trying to get pregnant, talk to your doctor about whether an SSRI is safe. Women who take an SSRI during pregnancy have a slightly higher chance of having a baby with birth defects.

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

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).

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.

SSRIs make bleeding more likely in the upper gastrointestinal tract (stomach and esophagus). Taking SSRIs with NSAIDs (such as Aleve or Advil) makes bleeding even more likely. Taking medicines that control acid in the stomach may help.

As with any medicine, some medicines can adversely interact with an SSRI. Discuss your medicine and dietary supplement use with your doctor 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 medicines can cause flu-like symptoms, headaches, nervousness, anxiety, or insomnia.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

Citations

  1. Kwan I, Onwude JL (2007). Premenstrual syndrome, search date November 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.

Credits

By Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Primary Medical Reviewer Brian D. O'Brien, MD - Internal Medicine
Specialist Medical Reviewer Kirtly Jones, MD, MD - Obstetrics and Gynecology
Last Revised July 26, 2010

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information.