ANTIDEPRESSANTS

FOR PMDs:

WHAT YOU SHOULD KNOW

Antidepressants—specifically, Selective Serotonin Reuptake Inhibitors (SSRIs)—are considered a first-line treatment for Premenstrual Dysphoric Disorder (PMDD). But while they can offer relief for many, they’re not a universal solution, and often come with limitations, side effects, and trial-and-error adjustments.

🧠 Why Antidepressants?

PMDD is not a mood disorder, but a hormone-related sensitivity of the brain to natural menstrual cycle changes. Serotonin, a brain chemical that influences mood and emotion, is closely linked to these hormone shifts. SSRIs work by increasing serotonin levels in the brain, which can help stabilize mood during the luteal phase (the two weeks before a period).

🌟 Effectiveness

  • About 60% of people with PMDD experience full relief of symptoms from SSRIs.¹

  • Others may see partial improvement or no meaningful change.

  • Some experience side effects such as nausea, fatigue, emotional numbness, or worsened symptoms.

  • Finding the proper medication, dosage, and dosing schedule can take weeks or months.

🕒 Dosing Options

There are three main ways SSRIs are prescribed for PMDD:

  1. Daily Dosing — taken every day, regardless of the menstrual cycle

  2. Luteal Phase Dosing — taken only during the second half of the menstrual cycle

  3. Symptom-Onset Dosing — taken only when symptoms begin

Each approach may work differently for each individual, and finding the right fit often involves experimentation under provider guidance.

⚠️ Important Considerations

  • SSRIs treat symptoms, not the root cause (hormone sensitivity).

  • They may not be effective for those with Premenstrual Exacerbation (PME) of another disorder, like depression or anxiety.

  • If SSRIs are ineffective or cause intolerable side effects, people often move on to hormonal treatments or surgical options.

📌 1. Sources: Bacchi, S., & Licinio, J. (2015). PMS and PMDD: Diagnosis and Treatment. Current Psychiatry Reports, 17(11), 87.; 2. Yonkers, K. A., et al. (2008). Practice guideline for the treatment of patients with PMDD. Journal of Clinical Psychiatry