Premenstrual Syndrome - Medications

Designer Antidepressants. Antidepressants with other actions are being studied.

Venlafaxine (Effexor) is a so-called designer antidepressant known as a serotonin-noradrenaline reuptake inhibitor. It is similar to fluoxetine (Prozac) in effectiveness and tolerability for most patients. Some trials have reported significant improvement in premenstrual dysphoria. Research is needed to determine whether intermittent treatment would be useful.
Studies have been mixed on the use of intermittent treatment with nefazodone (Serzone), another designer antidepressant. Two small studies reported benefits with the agent. Although a 2001 study reported no benefits with this agent, two other small studies, including one in 2002, reported relief. It should be noted that Serzone has been associated with increased risk of liver failure.

Studies are needed to determine if these drugs offer any additional benefits compared to standard SSRIs.

Tricyclics. Before the introduction of SSRIs, tricyclics, such as desipramine (Norpramin) or amitriptyline (Elavil, Endep), had been the standard treatment for depression. They are not very useful, in general, for premenstrual dysphoric disorder or other PMS symptoms. One exception may be clomipramine (Anafranil), which effects serotonin and has been helpful for some women. Patients report more side effects with anafranil than with SSRIs, although low doses are used for premenstrual syndrome and may be beneficial for some women. It is important that this drug not be taken with either SSRIs or other antidepressants known as monoamine oxidase inhibitors (MAOIs).

Antianxiety Drugs

Antianxiety drugs (called anxiolytics) may be helpful for women with severe premenstrual anxiety that is not relieved by SSRIs or other treatments.

Benzodiazepines. The standard anxiolytics are the benzodiazepines, with alprazolam (Xanax) most often used for PMS. Experts, however, generally do not recommend these drugs for PMS related anxiety. Dependence is a common danger and can occur after as short a time as three months of use. (Using Xanax for only a few days per month when symptoms are most severe reduces this risk.) Common side effects are daytime drowsiness and a hung-over feeling. Respiratory problems may be exacerbated. It should be noted that the drug also stimulates an increase in appetite, particularly for fats, during the premenstrual cycle. Overdose is very serious, although rarely fatal. Benzodiazepines are potentially dangerous when used in combination with alcohol.