COMPARISON OF FLUOXETINE, BUPROPION, AND PLACEBO IN THE TREATMENT OF PREMENSTRUAL DYSPHORIC DISORDER

Serotonergic antidepressants have been shown to be effective treatment s for premenstrual dysphoric disorder (PMDD). The efficacy of nonserot onergic antidepressants is less well studied. This study was a two-cen ter, parallel design, placebo-controlled, randomized trial of fluoxeti ne, bupropion, and placebo in women with PR IDD. Thirty-four women wit h PMDD completed 1 month of single-blind placebo and 2 months of fluox etine 20 mg/day (N = 10), bupropion 100 mg three times daily (N = 12), or placebo (N = 12). Clinical Global Impressions (CGI) Scale, an expa nded form of the Hamilton Rating Scale for Depression (HAM-D), and Glo bal Assessment Scale (GAS) ratings were obtained premenstrually in eac h of the three treatment cycles. The three treatment groups differed s ignificantly in efficacy by CGI ratings. Fluoxetine was superior to bo th bupropion and placebo. Comparison of posttreatment to pretreatment HAM and GAS scores demonstrated significant superior efficacy of fluox etine compared with placebo. Posttreatment HAM and GAS scores for bupr opion were intermediate between but not significantly different from f luoxetine or placebo. In summary, fluoxetine was significantly superio r to bupropion and placebo as an effective treatment for PMDD. Althoug h some improvement with bupropion was noted, and both medications were well tolerated, patient satisfaction was far greater with fluoxetine.