Premenstrual dysphoric disorder treatment

Differentiate between premenstrual syndrome and premenstrual dysphoric disorder with respect to pathophysiology, clinical presentation, and treatment. 

TREATMENT PREMENSTRUAL SYNDROME AND PREMENSTRUAL DYSPHORIC DISORDER... 

The current SSRIs in the United States inclnde fluoxetine, fluvoxamine, sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro). All effectively treat major depression. In addition, one or more of the SSRIs has been shown effective in the treatment of dysthymic disorder, the depressive phase of bipolar disorder, premenstrual dysphoric disorder, panic disorder, social phobia, obsessive-compnlsive disorder, bnlimia nervosa, and binge-eating disorder. 

In addition to their proven efficacy in the treatment of all types of depression, the SSRIs have been shown to be the drugs of choice in the treatment of panic disorder, obsessive-compulsive disorder, bulimia nervosa, and as an adjunct to the treatment of alcohol withdrawal and relapse prevention, premenstrual dysphoric disorder and post-traumatic stress disorder. The usefulness of these drugs in treating such a diverse group of disorders reflects the primary role of serotonin in the regulation of sleep, mood, impulsivity and food intake. 

The selective serotonin reuptake inhibitors (SSRI) have been used in adults for a wide variety of disorders, including major depression, social anxiety (social phobia), generalized anxiety disorder (GAD), eating disorders, premenstrual dysphoric disorder (PMDD), post-traumatic stress disorder (PTSD), panic, obsessive-compulsive disorder (OCD), trichotillomania, and migraine headaches. Some of the specific SSRI agents have an approved indication in adults for some of these disorders, as reviewed later in this chapter. The SSRIs have also been tried in children and in adults for symptomatic treatment of pain syndromes, aggressive or irritable ( short fuse ) behavior, and for self-injurious and repetitive behaviors. This chapter will review general aspects of the SSRIs and discuss their approved indications in children and adolescents. 

Freeman, E. W. (2004). Luteal phase administration of agents for the treatment of premenstrual dysphoric disorder. CNS Drugs 18, 453-468. 

Pearlstein TB, Halbreich U, Batzar ED, et al Psychosocial functioning in women with premenstrual dysphoric disorder before and after treatment with sertraline or placebo. J Clin Psychiatry 61 101-109, 2000... 

Yonkers KA, Halbreich U, Freeman E, et al Symptomatic improvement of premenstrual dysphoric disorder with sertraline treatment a randomized controlled trial. Sertraline Premenstrual Dysphoric Collaborative Smdy Group. JAMA 278 983-988, 1997... 

In this text, the focus of our discussion is on the last issue. To illustrate the problem, we consider the effect of gender on drug pharmacokinetics (see Chapter 3, Chapter 5, Chapter 7, Chapter 10, and Chapter 12) and then address two important gender-related questions the use of medications during pregnancy and the drug treatment of premenstrual dysphoric disorder (see Chapter 14). 

Yonkers KA, Brown WA. Pharmacologic treatments for premenstrual dysphoric disorder. Psychiatr Ann 1996 26 596-589. 

Some of the growth in antidepressant use may be related to the broad application of these agents for conditions other than major depression. For example, antidepressants have received FDA approvals for the treatment of panic disorder, generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). In addition, antidepressants are commonly used to treat pain disorders such as neuropathic pain and the pain associated with fibromyalgia. Some antidepressants are used for treating premenstrual dysphoric disorder (PMDD), mitigating the vasomotor symptoms of menopause, and treating stress urinary incontinence. Thus, antidepressants have a broad... 

Halbreich U et al Are there differential symptom profiles that improve in response to different pharmacological treatments of premenstrual syndrome/premenstrual dysphoric disorder CNS Drugs 2006 20(7) 523. [PMID 16800714]... 

Sultana D, Peindl KS, Wisner KL. Rash associated with St. John s Wort treatment in premenstrual dysphoric disorder. Arch Womens Ment Health 2000 3 99-101. 

Atmaca M, Kumru S, Tezcan E. Fluoxetine versus V. agnus-castus extract in the treatment of premenstrual dysphoric disorder. Hum Psychopharmacol Clin Exp 2003 18 191-195. 

Cohen, L. S., C. N. Soares, A. Lyster, P. Cassano, M. Brandes and G. A. Leblanc (2004). Efficacy and tolerability of premenstrual use of venlafaxine (flexible dose) in the treatment of premenstrual dysphoric disorder. J Clin Psychopharmacol 24(5) 540-3. 

Halbreich, U., R. Bergeron, K. A. Yonkers, E. Freeman, A. L. Stout and L. Cohen (2002). Efficacy of intermittent, luteal phase sertraline treatment of premenstrual dysphoric disorder. Obstet Gynecol 100(6) 1219-29. 

Scott and White hospital in Texas is an example of a pharmacy-run women s health clinic. In this model, the obstetrics-gynecology physician or nurse identifies patients at risk for mood disorders, including premenstrual syndrome and premenstrual dysphoric disorder, and refers them to the pharmacist for further evaluation, treatment, and drug therapy monitoring. Patient approval ratings were 96% excellent. 

FIGURE 78-1. Algorithm for the treatment of premenstrual dysphoric disorder (PMDD). 

Luisi AF, Pawasauskas JE. Treatment of premenstrual dysphoric disorder with selective serotonin reuptake inhibitors. Pharmacotherapy 2003 23 1131-1140. 

Freeman EW, Kroll R, Rapkin A, et al. Evaluation of a unique oral contraceptive in the treatment of premenstrual dysphoric disorder. J Womens Health Gend Based Med 2001 10 561-569. 

The symptoms of premenstrual syndrome (PMS), also called premenstrual dysphoric disorder, include depressed mood, anxiety, affective lability, and anger or irritability.79 Since low serotonin levels are thought to be involved in the etiology of depression, aggression, and impulsivity,80 specific serotonin reuptake inhibitors have been tested in PMS. The SSRI fluoxetine was found to be better than placebo.81 Since chronic treatment with SSRIs can influence many neuron systems other than serotonin,82 Steinberg et al.83 designed a study using tryptophan, relatively specific for its effect on serotonin, on the effects of symptoms of PMS. In a randomized controlled clinical trial, 37... 

Freeman EW, Sondheimer SJ. Premenstrual dysphoric disorder recognition and treatment. J Clin Psychiatry 2003 5 30-39. 

Monoamine oxidase inhibitors, such as SSRIs, have been shown to be effective in the treatment of depression, and they have become among the most widely used prescription drugs in the United States. Prozac is used not only to treat major depressive disorders but also bulimia nervosa, obsessive-compulsive disorder, panic disorder, and premenstrual dysphoric disorder. Multiple serotonin receptor subtypes are involved. Specific serotonin receptor subtype agonists and antagonists have been radiolabeled with positron-emitting tracers to assess the state of the serotonergic system. 

---