Fluoxetine in the Treatment of Premenstrual Dysphoric Disorder

Abstract

OBJECTIVE:

To examine the role of fluoxetine in the treatment of premenstrual dysphoric disorder (PMDD).

DATA SOURCES:

Search strategy included MEDLINE (1966–February 2002), Embase (1988–February 2002), HealthStar (1975–December 2000), Current Contents (1996–November 2001), and Copernic (November 2001). Search terms included fluoxetine, premenstrual dysphoric disorder, PMDD, late luteal-phase dysphoric disorder, and severe premenstrual syndrome.

STUDY SELECTION:

English-language human studies were selected and evaluated based on quality of evidence.

DATA SYNTHESIS:

Eight prospective trials (3 double-blind, placebo-controlled, crossover; 3 double-blind, randomized, controlled; 2 open-label), 1 case series, and 1 meta-analysis were identified. Although 6 of the studies involved small sample sizes (n < 50), all found fluoxetine to be effective in the treatment of PMDD.

CONCLUSIONS:

Despite limited data, fluoxetine 20 mg/d appears to be effective in the treatment of PMDD. However, adverse effects, particularly headaches and sexual dysfunction, are possible. Given the long half-life of fluoxetine and the short duration of PMDD symptoms per cycle, larger, well-designed clinical trials evaluating intermittent dosing for only 1 week or a few doses need to be performed.