Fluoxetine Effective in Premenstrual Dysphoric Disorder

Laurie Barclay, MD

September 05, 2002

Sept. 6, 2002 — Premenstrual treatment with fluoxetine, 20 mg daily, was effective in treating moods and physical and social functioning symptoms associated with premenstrual dysphoric disorder (PMDD), according to the results of a placebo-controlled clinical trial reported in the September issue of Obstetrics and Gynecology.

"Fluoxetine 20 mg appears to have comparable tolerability with, and better efficacy than, fluoxetine 10 mg," write Lee S. Cohen, MD, from Massachusetts General Hospital in Boston, and colleagues.

From 14 days before the next expected menses through the first day of full bleeding, 260 women were randomized to daily treatment for three cycles with fluoxetine 10 mg, fluoxetine 20 mg, or placebo. Compared with placebo, the group treated with fluoxetine 20 mg had significant improvement in Daily Record of Severity of Problems luteal and total scores, and in symptoms of breast tenderness, bloating, and joint or muscle pain. Both fluoxetine groups had significantly more improvement in mood-related symptoms than did the placebo group. Discontinuation rate due to adverse events was similar in the three groups.

"Symptom improvement occurred as early as the first cycle of treatment and was sustained across the treatment cycles for fluoxetine 20 mg," the authors write. "Given this finding, it seems likely that the mechanism underlying response to fluoxetine in patients with premenstrual dysphoric disorder is distinct from that postulated for major depression, which involves postsynaptic downregulation of serotonergic receptors over a period of weeks."

Eli Lilly and Company supported this study and has financial relationships with its authors.

Obstet Gynecol. 2002;100:435-444

Reviewed by Gary D. Vogin, MD

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