An in-depth review of the safety and efficacy of treatments for premenstrual dysphoric disorder (PMDD) has been published in the Journal of Psychiatric Practice.

Researchers from the University of Texas Southwestern Medical Center conducted a comprehensive review of proposed treatments for PMDD in order to aid healthcare professionals on effective clinical decision making. PMDD treatments were categorized as psychiatric, anovulatory, supplements, herbal, and non-pharmacologic.

The exact cause of PMDD is not established but one factor seems to be the negative effects of changing hormone levels on certain neurotransmitters, including serotonin. Data from 31 randomized trials, including over 4,000 women, have demonstrated the use of selective serotonin reuptake inhibitors (SSRIs) as first-line treatment for PMDD. More research is needed to determine whether treatment that is continuous, semi-intermittent, or started at symptom onset is best in balancing efficacy and adverse reactions.

If response to SSRI therapy is inadequate, women should consider alternate options such as other antidepressants or anti-anxiety medications to help manage PMDD-related symptoms. Combination oral contraceptives containing drospirenone/ethinyl estradiol have proven effective and are recommended for women with PMDD who also want contraception.

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Anovulatory treatments are an effective option when the above treatments fail, researchers report. However, these options are considered third-line due to potential adverse reactions and high cost. Among the supplements and herbal-related therapies proposed, only calcium supplementation has demonstrated a consistent therapeutic benefit.

Larger, placebo-controlled studies of potential PMDD treatments that include a placebo screening period to confirm the diagnosis as well as a standard definition for PMDD and outcome measures are needed, the authors concluded.

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