The pharmacologic management of premenstrual dysphoric disorder.
Premenstrual dysphoric disorder (PMDD) is characterized by physical, affective and behavioral symptoms that are linked to the luteal phase of the menstrual cycle and relieved soon after the onset of menses. The disorder is chronic and exerts a major impact on personal relationships and occupational productivity for the estimated 6% of reproductive-aged women who fulfill strict PMDD criteria and the almost 20% of women who nearly meet these criteria. There are now various pharmacologic options that have demonstrated efficacy for PMDD and two of these approaches have an approved indication for treatment from the US FDA: three selective serotonin re-uptake inhibitors; and for women who also desire hormonal contraception, a low dose oral contraceptive pill containing the progestin drospirenone, in a new dosing regimen. Due to the unique pathophysiology of the disorder, the selective serotonin re-uptake inhibitors can be effectively administered intermittently, with dosing limited to the luteal phase of the cycle (2 weeks prior to menses). In the future, new pharmacotherapy will likely evolve from research evaluating other hormonal formulations that inhibit ovulation, without simulating PMDD-like symptoms, or novel pharmacologic agents that modulate the central neurotransmission.
Rapkin
Andrea J
AJ
Department of Obstetrics & Gynecology, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, California 90095-1740, USA. arapkin@mednet.ucla.edu
Winer
Sharon A
SA
D018759:Adrenergic Uptake Inhibitors / Q000627:therapeutic use; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D015897:Comorbidity; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D019964:Mood Disorders / Q000453:epidemiology; D034445:Ovulation Inhibition; D011293:Premenstrual Syndrome / Q000188:drug therapy* / Q000453:epidemiology; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use
D018759:Adrenergic Uptake Inhibitors; D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D003278:Contraceptives, Oral, Hormonal; D007987:Gonadotropin-Releasing Hormone; D006993:Hypnotics and Sedatives; D017367:Selective Serotonin Reuptake Inhibitors