PHARMACOLOGICAL MANAGEMENT OF PREMENSTRUAL DISORDER

Over the last decade there has been increasing recognition of premenst rual disorders, and numerous treatments have been tried for symptom re lief. A literature search using Medline was conducted to locate all ar ticles written in English and including the terms ''premenstrual treat ment,'' ''premenstrual syndrome,'' ''late luteal phase dysphoric disor der,'' or ''menstruation and mood'' over the last 30 years. Although m ore than 300 articles were retrieved, only one-third of them described double-blind studies and just 41 of the double-blind studies involved prospectively diagnosed patients. The definition of the disorder vari ed across studies as did research design and outcome measures. Many st udies did not assess for Axis I comorbidity, which may have a signific ant impact on drug response. We attempted to do a metaanalysis of the existing double-blind, prospectively diagnosed studies, broken down by drug class and symptom reduction. However, we could not make statisti cal comparisons within or across drug groups to assess efficacy of tre atment for specific symptoms due to differences in outcome-assessment measures across studies. Several promising pharmacological strategies exist to treat the patient with premenstrual dysphoric disorder. We re view double-blind studies for each class of drugs, highlight some open studies, and present guidelines. Additional double-blind studies with prospectively diagnosed patients are needed. Standardization of defin ition, design, and outcome measures used in this field is important to enable direct comparison across studies of different treatment strate gies.