Use of SSRIs in PMS and PMDD management

Cochrane Database Syst Rev 2024. doi:10.1002/14651858.CD001396.pub4

In the 2 weeks leading up to menstruation (the luteal phase), premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD), a severe form of the syndrome, can cause physical, emotional and social symptoms of distress in women of reproductive age. This is a poorly understood spectrum of conditions with a high personal and social impact. This Cochrane review examined the use of selective serotonin receptor inhibitors (SSRIs) in the management of these conditions. Thirty-four randomised controlled trials comparing SSRIs (ie, fluoxetine, paroxetine, sertraline, escitalopram and citalopram) to placebo were included in this systematic review, which revealed suspected publication bias and showed that heterogenicity was low or absent for most of the study outcomes. Overall, there appeared to be a probable benefit of continuous SSRI use compared with placebo or luteal phase use in reducing premenstrual symptoms. However, SSRI use has associated adverse side effects, the most common being nausea, asthenia and somnolence. The high burden of these conditions on individuals and the wider community means that this is a promising discovery; however, further research into …