For women of reproductive age, premenstrual syndrome (PMS) is an unfortunate fact of life. PMS symptoms are both painful and annoying, but usually respond well enough to home care and over-the-counter remedies. In some cases, however, the symptoms of PMS can be severe enough to interfere with virtually all aspects of daily life and functioning.
In the past, doctors have prescribed hormonal contraceptives as a way to dampen the natural menstrual cycle. Concerns about the safety of indefinite hormone treatments have recently caused this approach to fall out of favor. Instead, antidepressants belonging to the category of selective serotonin reuptake inhibitors (SSRIs) have become one of the preferred methods for managing severe PMS. Paxil (paroxetine), Prozac (fluoxetine) and Zoloft (sertraline) have all been approved for this usage. Questions remain, though, about how long an SSRI treatment regimen ought to continue so as to achieve long-term success.
A recent clinical study tested whether a shorter or longer course of treatment with Zoloft was best for dealing with severe PMS. Designers of the study were interested in seeing if and when participants relapsed. Each participant was given a complete physical exam and their PMS symptoms were scored on a standardized scale. Short-term treatment consisted of four months of Zoloft treatment followed by 14 months with placebo. Long-term treatment lasted an entire year, with just six months of placebo at the end of the study. Before the experiment, researchers believed that participants in the long-term group would show lower rates of relapse as well as longer times to relapse. To their surprise, neither condition turned out to be the case.
The biggest predictor of relapse actually turned out to be initial severity of PMS symptoms. Women with more severe PMS were more likely to relapse than those with only moderate PMS. Between both treatment conditions, about 70% of participants had shown remission of their symptoms by the third month. Half of these would later relapse, mostly within six-to-eight months after switching to placebo.
A surprisingly high proportion of women relapsed during their treatment with Zoloft, a finding that may be explained by the placebo effect. In other words, the benefits of medication for some participants were largely psychological and prone to wearing off. Adverse side effects of Zoloft included insomnia, headache, dizziness, and dry mouth, but in no case were these symptoms more than an annoyance.
A single study of course cannot answer every question about PMS treatment with antidepressants. The evidence remains murky as to whether Zoloft truly represents a benefit to women suffering through severe PMS. While odds are encouragingly high that Zoloft will bring about improvement, odds are just as high that relapse is inevitable. More study is required before perhaps a superior treatment for PMS is discovered.
- Freeman, E.W., Rickels, K., Sammel, M.D., Lin, H. & Sondheimer, S.J. (2009). Time to relapse after short-term or long-term sertraline treatment for severe premenstrual syndromes. Archives of General Psychiatry, 66, (5), 537-544.
- Sertraline – PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved April 6, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001017/
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