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Not Just Any Antidepressant for PMS
Selective serotonin reuptake inhibitors (SSRIs) have improved the treatment of premenstrual mood symptoms. Studies have demonstrated the efficacy of each one that has become available and been tested for this purpose. However, it is unclear whether the serotonergic effects or a generic antidepressant effect is responsible for the therapeutic response. This study compared sertraline hydrochloride, an SSRI, with desipramine hydrochloride, a more adrenergic tricyclic antidepressant, for the treatment of severe premenstrual syndrome. After 3 months of screening, 189 subjects were randomized to 3 months of double-blind treatment with placebo or one of these agents, on a flexible dosage (range, 50 to 150 mg/day). Four well-validated psychological questionnaires were used to measure outcome.
For all measures of mood, sertraline treatment was significantly more effective than desipramine (p<0.001), the effect of which did not differ from that of placebo. Among sertraline patients, 60% rated themselves as at least much improved, as compared with 38% and 29% in the desipramine and placebo groups, respectively (p=0.003). A history of depression had no effect on treatment outcome.
Comment: This study has implications beyond our improved understanding of the neurotransmitter system most affected in premenstrual mood symptoms. There is considerable pressure to reduce pharmaceutical costs, and inexpensive, generic forms of tricyclic antidepressants are now available. This study suggests that these generic preparations are not a substitute for the SSRIs in the patient with PMS.
— NL Stotland
Published in Journal Watch Women's Health December 1, 1999
Citation(s):
Freeman EW et al. Differential response to antidepressants in women with premenstrual syndrome/premenstrual dysphoric disorder. Arch Gen Psychiatry 1999 Oct 56 932-939.
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