The role of fluoxetine in the treatment of premenstrual dysphoric disorder

Many women experience psychological and physical symptoms associated with t he menstrual cycle, commonly referred to as premenstrual syndrome (PMS). Fo r the 3% to 5% of women who meet Diagnostic and Statistical Manual of Menta l Disorders, Fourth Edition criteria for premenstrual dysphoric disorder (P MDD), symptoms are severe and impair social and occupational functioning. A lthough the etiology of PMDD is unknown, symptoms of dysphoria, including d epression and anxiety, predominate and indicate a link to serotonergic neur otransmission. Pharmacotherapy trials have shown greater efficacy with sero tonergic versus nonserotonergic compounds. We reviewed the published litera ture and found 7 controlled and 4 open-label clinical trials of fluoxetine, a selective serotonin reuptake inhibitor, in the treatment of PMDD. These trials demonstrate that PMDD symptoms decreased during treatment with fluox etine. Preliminary findings suggest that intermittent luteal-phase fluoxeti ne dosing may also be a suitable treatment strategy for selected patients w ith PMDD. At 20 mg/d, adverse events were usually transient, rarely caused discontinuation, and were consistent with fluoxetine's known safety profile . Fluoxetine 20 mg/d is an effective and well-tolerated treatment for women with PMDD, a severe variant of PMS.