Comment: The quality of evidence is downgraded by heterogeneity.
A Cochrane review [Abstract] 1 included 34 studies. SSRIs were effective in treating the premenstrual symptoms (standardized mean difference SMD −0.57, 95% CI −0.72 to −0.42; I²=51%; 12 studies, n=1742). Secondary analysis showed that they were effective in treating physical, functional and behavioural symptoms. SSRI treatment was more effective when administered continuously than when administered only in the luteal phase. All SSRIs (fluoxetine, paroxetine, sertraline, escitalopram, and citalopram) were effective. The most common side effects associated with a moderate dose of SSRIs were nausea, asthenia or decreased energy, and somnolence.
A double-blind, placebo-controlled, multisite, parallel-group randomized clinical trial 3 included 252 women with PMDD. Treatment (placebo or sertraline hydrochloride, 50 to 100 mg/d) was started at symptom onset and continued until the first few days of menses for 6 menstrual cycles. At baseline the mean (SD) PMTS scores for sertaline and placebo were 22.3 (4.8) and 21.4 (4.5), respectively, which declined to 11.7 (6.8) and 12.0 (6.9), respectively; group mean difference, 1.88 (95% CI, 0.01-3.75; P = .06). The mean (SD) estimated difference in IDS-C scores between baseline (35.4 [10.7] for sertraline; 32.8 [10.4] for placebo) and the end point (15.3 [10.7] for sertraline; 17.8 [11.0] for placebo) favored the sertraline group by 5.14 (95% CI, 1.97-8.31) points (P = .02). Compared with the placebo group, those assigned to sertraline showed greater improvement on the total DRSP score (estimated mean difference, 1.09 [95% CI, 0.96-1.25] points; P = .02) and Anger/Irritability DRSP subscale score (1.22 [95% CI, 1.05-1.41] points; P < .01) and were more likely to respond to treatment (77 of 115 patients [67.0%] for sertraline and 65 of 124 [52.4%] for placebo; χ21 = 5.23; P = .02).
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Primary/Secondary Keywords