“Selective serotonin reuptake barriers (SSRIs) are extremely effective for PMDD,” says Andrew Novick, MD, PhD, an assistant professor of psychiatry at CU Anschutz and psychiatrist at the Women’s Behavior Health and Wellness Center in Aurora, Colorado.
SSRIs are actually more effective at treating PMDD than they are for major depressive disorder or generalized anxiety disorder, says Dr. Novick.
Many double-blind, randomized controlled trials have shown SSRIs to be effective in treating the emotional and physical symptoms of PMDD in many (though not all) women. In general, lower doses of SSRIs are used to treat PMDD.
“SSRIs are first-line treatment, and we often see really quick, amazing results with the drugs,” he says.
Interestingly, SSRIs aren’t used for their serotonin properties for PMDD, as is the case when people take them every day for anxiety and depression, says Shah. “We use them to stimulate the brain into making sure the steroid hormones are as stable as they can be during the end of the menstrual cycle,” says Shah.
Hormonal birth control pills that have drospirenone and ethinyl estradiol are also used to treat PMDD and can be used along with SSRIs.
While there may be a link between inflammation and PMDD symptoms, there isn’t evidence that histamine is causing or controlling symptoms in PMDD, says Novick.
“If strong research does end up coming out that we should be using antihistamines in PMDD, I would be excited to embrace it — the more tools we have in our arsenal to treat this disorder, the better,” he says.
But for right now, Novick doesn’t believe there’s enough evidence to start recommending antihistamines for PMDD.
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