Effective treatment of premenstrual dysphoric disorder (PMDD)

Most women of reproductive age experience premenstrual symptoms that can be physical or affective in nature. Approximately 5% of these women experience severe premenstrual symptoms that markedly influence their work, social activities or relationships. Prospective charting of premenstrual symptoms for at least 2 menstrual cycles is required to facilitate an accurate diagnosis of this condition. While many women will meet the diagnostic criteria for PMS or PMDD, others may demonstrate premenstrual worsening of a pre-existing condition or a continuous or intermittent condition unrelated to the menstrual cycle. Treatment of women with PMS or PMDD should begin with conservative and low-risk interventions, followed by the use of prescribed, evidence-based pharmacologic therapies. Low-dose therapy with an SSRI such as fluoxetine has demonstrated excellent efficacy with minimal side effects, and increasing evidence suggests that intermittent treatment is as efficacious as continuous daily administration. Second-line therapy, modification of the menstrual cycle, should be considered only after all other treatment options have failed.