Zoloft may ease some Premenstrual Problems

Women who get moderately moody and irritable around the time of menstruation may be able to take an antidepressant to get relief, new research suggests.Doctors routinely use antidepressants to treat women with very severe premenstrual syndrome, called premenstrual dysphoric disorder, said Dr. Susan Kornstein, a professor of psychiatry and obstetrics and gynecology at Virginia Commonwealth University.But doctors have not had much to offer women with less severe symptoms. And typically, treating severe premenstrual problems requires the drugs to be taken for two weeks or all month.Kornstein was lead investigator on a study that looked at treating women with moderate symptoms using low doses of the antidepressant sertraline, sold under the brand name Zoloft. The study was funded by Pfizer Inc., which makes Zoloft.Sertraline is also available as a generic. Other antidepressants such as fluoxetine, the generic version of Prozac, also are used to treat PMS.The study also looked at whether there were differences depending on when the drugs were taken during the menstrual cycle."Premenstrual syndrome is very common," said Kornstein, who is executive director of the VCU Institute for Women's Health and the VCU Mood Disorders Institute."This is the first antidepressant study that has focused on this group. It looks like those women do benefit from an antidepressant. I'm not saying all women with PMS should be treated with antidepressants, but for women who have moderate to severe symptoms that are causing them distress, this is a treatment option to consider."Symptoms of premenstrual syndrome can include irritability, moodiness, bloating, fatigue, anger, headache, breast tenderness, abdominal pain and backache, weight gain, acne flare-ups, constipation or diarrhea, decreased coordination, depression and food cravings.Symptoms can be severe enough to interfere with relationships and work, said Donna Pinnell, a women's health nurse practitioner at Virginia Women's Center."PMS is very real," Pinnell said. "We have patients complaining of mild to severe PMS symptoms. It can affect their day-to-day living, their relationships with partners, other family members and co-workers. "The study, published in the Journal of Clinical Psychiatry, enrolled 314 women ages 25 to 45 at 22 sites throughout the country. Women were randomly chosen to get a placebo, an inactive dummy drug, or 25 to 50 milligram doses of sertraline for four menstrual cycles.The study was designed to look at dosing during the luteal or post-ovulation phase of the menstrual cycle, which starts at ovulation and ends the day before the period begins. In general, ovulation occurs about midway or 14 days into the menstrual cycle. The researchers also looked at dosing continuously through the menstrual cycle and symptom-onset dosing, tracking women for one menstrual cycle for each method.When used to treat depression, antidepressants often take several weeks before patients feel or notice a difference in their symptoms. The notion to study symptom-onset dosing came out of what Kornstein said she and others were seeing in practice -- women were getting relief soon after taking the drugs."They would be prescribed luteal-phase dosing, but they would forget to start their medication and then they would remember when their symptoms began," Kornstein said. "Lo and behold, it seemed to be working."Because the study tracked only women for one cycle of symptom-onset dosing, the results are not definitive."Why it starts to work so quickly that is the million-dollar question," Kornstein said.

Written by Tammie Smith, study done by VCU Mood Disorders Institute. Published in the Nov 24, 2006