SERTRALINE VERSUS DESIPRAMINE IN THE TREATMENT OF PREMENSTRUAL-SYNDROME - AN OPEN-LABEL TRIAL

Background: Antidepressant medications have appeared to be effective t reatments for premenstrual syndrome (PMS) in several small trials. Thi s open-label study examined the efficacy of and tolerance for a new se rotonergic antidepressant compared with a traditional tricyclic antide pressant in PMS treatment. Method: For two menstrual cycles in women m eeting well-defined criteria for PMS, an open-label comparison of the serotonin selective sertraline (N = 17) and the noradrenergic desipram ine (N = 15) was performed. Dose was flexible, with a mean dose in the second cycle of 87 mg/day for sertraline and 110 mg/day for desiprami ne. Outcome measures were the premenstrual daily symptom report (DSR) scores and the Hamilton Rating Scale for Depression (HAM-D). Results: Sertraline and desipramine reduced depressive symptoms as assessed by the HAM-D, both achieving similar reductions in the HAM-D scores. Redu ction of total premenstrual symptoms as assessed by the DSR score was observably greater with sertraline, but the difference compared with d esipramine was not statistically significant in this small sample. Sub jects were more likely to perceive desipramine side effects as intoler able; 4 of the 15 desipramine-treated subjects discontinued compared w ith none in the sertraline group. Subjects who were previously treated in a PMS program without good therapeutic response were less likely t o respond to either medication, suggesting a treatment-resistant group . Conclusion: Sertraline and possibly desipramine appear to be effecti ve treatments for PMS. Sertraline was better tolerated, resulting in g reater patient acceptance. A placebo-controlled trial in which subject s are randomly assigned to the medication is clearly needed to support or refute these preliminary findings.