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Selective Serotonin Reuptake Inhibitors (SSRIs) for PMS

fluoxetine hydrochloride (Prozac)
paroxetine hydrochloride (Paxil)
sertraline hydrochloride (Zoloft)

These drugs may be taken orally every day, throughout the menstrual cycle, or just taken when premenstrual syndrome (PMS) symptoms are present in the 2 weeks before a woman's period.

How It Works

These drugs, called selective serotonin reuptake inhibitors (SSRIs), improve mood by affecting the levels of a chemical messenger in the brain (neurotransmitter) called serotonin.

Why It Is Used

SSRIs may be used when:

• Depression, mood changes, and other behavioral or emotional disturbances are major symptoms of PMS.
• Depression becomes worse during the premenstrual phase.

How Well It Works

Studies have shown that the SSRIs make depression, irritability, and other behavioral and mood-related symptoms of PMS less severe. For some women, these drugs may also improve physical symptoms such as fatigue, appetite, bloating, breast pain, or insomnia.

Controlled studies have shown SSRIs are effective in relieving PMS symptoms. It may be that taking SSRIs in the 2 weeks before menstrual bleeding is more effective than taking them every day. Further studies are being done.

Side Effects

Side effects of SSRIs can include:

• Nausea, appetite changes, weight loss.
• Headache.
• Insomnia, fatigue.
• Nervousness.
• Loss of sexual desire or ability.
• Dizziness.
• Tremors.

SSRIs have not been shown to cause birth defects or other complications if a woman becomes pregnant while taking these medications.

See Drug Reference for a full list of side effects.

What to Think About

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These drugs may take 2 to 3 weeks to effectively relieve PMS symptoms. Studies seem to show that an SSRI used in the 2 weeks before menstrual bleeding may relieve symptoms better than an SSRI used every day.

Recent studies have shown that SSRIs can be very effective in treating PMS. A new SSRI, similar to fluoxetine (Prozac) is pending approval by the Food and Drug Administration to be used for treating PMS.

The benefits and effectiveness of SSRIs need to be compared with the side effects and costs of treatment. You can discuss this with your health professional.

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