PAROXETINE AS A TREATMENT FOR PREMENSTRUAL DYSPHORIC DISORDER

Research into the psychobiology of premenstrual dysphoric disorder (PD D) finds alterations in markers associated with serotonergic neurotran smission. Supporting this is work showing that patients with PDD respo nd to some agents that block the reuptake of serotonin. In this open t rial, patients were treated for one cycle with placebo and then for th ree consecutive cycles with the serotonin reuptake inhibitor paroxetin e. The study population was composed of 14 participants who met DSM-IV criteria for PDD with moderate to severe symptomatology and specifica lly endorsed anger and irritability; as a central premenstrual complai nt. Patients showed modest improvement over the course of the pretreat ment evaluation, with significant improvement occurring for feelings o f worthlessness, decreased interest, and low energy. The effects of ac tive treatment were marked by the first active cycle with luteal phase 17-item Hamilton Rating Scale for Depression scores decreasing from 1 4.9 (+/-5.3) to 8.2 (+/-4.9) in the first, 7.8 (+/-5.1) in the second, and 7.8 (+/-6.8) in the third active treatment cycles (F[1,13] = 17.6 ; p < 0.0001). A group of items from daily ratings indicative of anger and irritability (mood swings, anger and irritability, behavioral dys control, and interpersonal conflicts) also showed improvement (F[1,13] = 5.94; p < 0.03). Various definitions of response were applied to tr eatment completers. The most conservative measure, the Clinical Global Impression (CGI), revealed that 7 of 14 patients had a complete respo nse (CGI = 1 or 2) whereas 4 patients had a partial response (CGI = 3) . These open trial findings are consistent with the notion that paroxe tine is effective in the acute phase for the treatment of PDD.