Psychosocial functioning in women with premenstrual dysphoric disorder before and after treatment with sertraline or placebo

Background: The objective of this study was to evaluate the pretreatment ps ychosocial functioning of women with premenstrual dysphoric disorder (PMDD) and the effect of sertraline treatment on psychosocial functioning in thes e patients. Method: Two hundred forty-three women recruited from 12 university-affiliat ed sites and meeting DSM-IV criteria for PMDD completed 1 cycle of single-b lind placebo and were randomly assigned to flexible dose sertraline or plac ebo for 3 cycles. Psychosocial functioning was assessed by the Daily Record of Severity of Problems (DRSP), the Social Adjustment Scale (SAS), and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). Results: SAS scores during the follicular phase were similar to SAS scores of community norms, whereas the pretreatment SAS and Q-LES-Q scores during the luteal phase were similar to scores of women with depressive disorders. Sertraline was significantly more effective than placebo in improving psyc hosocial functioning as measured by the SAS, the Q-LES-Q, and the 3 DRSP it ems of impaired productivity, interference with social activities, and inte rference with relationships with others. Improvement in psychosocial functi oning assessed by SAS and Q-LES-Q correlated with improvement in symptomato logy assessed by the Clinical Global Impressions-Improvement (CGI-I) scale and the Hamilton Rating Scale for Depression (HAM-D). Remitters (CGI-I scor e of 1) were more likely to function better at baseline and showed larger i mprovements in functioning and quality of life with treatment compared with nonremitters. Conclusion: Sertraline was superior to placebo in improving psychosocial fu nctioning in women with PMDD as reflected by SAS, Q-LES-Q, and DRSP measure s. Functional improvement correlated with improvement in premenstrual sympt omatology and was apparent by the second cycle of treatment. Comparison of pretreatment SAS scores in women with PMDD with the scores of other populat ions of women documents the degree of luteal phase functional impairment in women with PMDD and a relative absence of follicular phase impairment.