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Selective Serotonin Reuptake Inhibitors for Premenstrual Syndrome and Premenstrual Dysphoric Disorder: A Meta-Analysis

Shah, Nirav R. MD, MPH1,2; Jones, J B. MBA2; Aperi, Jaclyn MA1; Shemtov, Rachel MD1; Karne, Anita MD, MSc3; Borenstein, Jeff MD, MPH4

doi: 10.1097/AOG.0b013e31816fd73b

OBJECTIVE: To systematically review evidence of the treatment benefits of selective serotonin reuptake inhibitors (SSRIs) for symptoms related to severe premenstrual syndrome (PMS) and premenstrual dysphoric disorder.

DATA SOURCES: We conducted electronic database searches of MEDLINE, Web of Science, Cochrane Library, Embase, PsycINFO, and Cinahl through March 2007, and hand-searched reference lists and pertinent journals.

METHODS OF STUDY SELECTION: Studies included in the review were double-blind, randomized, controlled trials comparing an SSRI with placebo that reported a change in a validated score of premenstrual symptomatology. Studies had to report follow-up for any duration longer than one menstrual cycle among premenopausal women who met clinical diagnostic criteria for PMS or premenstrual dysphoric disorder. From 2,132 citations identified, we pooled results from 29 studies (in 19 citations) using random-effects meta-analyses and present results as odds ratios (ORs).

TABULATION, INTEGRATION, AND RESULTS: Our meta- analysis, which included 2,964 women, demonstrates that SSRIs are effective for treating PMS and premenstrual dysphoric disorder (OR 0.40, 95% confidence interval [CI] 0.31–0.51). Intermittent dosing regimens were found to be less effective (OR 0.55, 95% CI 0.45–0.68) than continuous dosing regimens (OR 0.28, 95% CI 0.18–0.42). No SSRI was demonstrably better than another. The choice of outcome measurement instrument was associated with effect size estimates. The overall effect size is smaller than reported previously.

CONCLUSION: Selective serotonin reuptake inhibitors were found to be effective in treating premenstrual symptoms, with continuous dosing regimens favored for effectiveness.

Selective serotonin reuptake inhibitors are effective pharmacologic treatments for premenstrual syndrome and premenstrual dysphoric disorder. Supplemental Digital Content is Available in the Text.

From the 1Division of General Internal Medicine, New York University School of Medicine, New York, New York; 2Center for Health Research, Geisinger Health System, Danville, Pennsylvania; 3Division of General Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; and 4Cedars-Sinai Department of General Internal Medicine and Health Services Research, Los Angeles, California.

Presented as a poster at the Society of General Internal Medicine Annual Meeting in Toronto, Canada, April 25–27, 2007.

Supported by grant number 5305535 from Berlex Laboratories, Inc. (Montville, NJ) and the New York University School of Medicine.

Corresponding author: Nirav R. Shah, MD, MPH, 423 East 23rd Street - 15N, New York, NY 10010; e-mail:

Financial Disclosure Dr. Shah has received unrestricted research grants from GlaxoSmithKline (Philadelphia, PA), Novartis (Basel, Switzerland), AstraZeneca (Wilmington, DE), Roche (Basel, Switzerland), Berlex (Montville, NJ), and Pfizer (New York, NY) and has been a consultant for Cerner Health Insights (Los Angeles, CA) and LifeTech Research (Baltimore MD). Dr. Borenstein has received research grants and a served as a consultant for Berlex. The other authors do not have any potential conflicts of interest to disclose.

© 2008 The American College of Obstetricians and Gynecologists