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Diagnosis and treatment of premenstrual dysphoric disorder.
Am Fam Physician. 2002 Oct 01; 66(7):1239-48.AF

Abstract

From 2 to 10 percent of women of reproductive age have severe distress and dysfunction caused by premenstrual dysphoric disorder, a severe form of premenstrual syndrome. Current research implicates mechanisms of serotonin as relevant to etiology and treatment. Patients with mild to moderate symptoms of premenstrual syndrome may benefit from nonpharmacologic interventions such as education about the disorder, lifestyle changes, and nutritional adjustments. However, patients with premenstrual dysphoric disorder and those who fail to respond to more conservative measures may also require pharmacologic management, typically beginning with a selective serotonin reuptake inhibitor. This drug class seems to reduce emotional, cognitive-behavioral, and physical symptoms, and improve psychosocial functioning. Serotoninergic antidepressants such as fluoxetine, citalopram, sertraline, and clomipramine are effective when used intermittently during the luteal phase of the menstrual cycle. Treatment strategies specific to the luteal phase may reduce cost, long-term side effects, and risk of discontinuation syndrome. Patients who do not respond to a serotoninergic antidepressant may be treated with another selective serotonin reuptake inhibitor. Low-dose alprazolam, administered intermittently during the luteal phase, may be considered as a second-line treatment. A therapeutic trial with a gonadotropin-releasing hormone agonist or danazol may be considered when other treatments are ineffective. However, the risk of serious side effects and the cost of these medications limit their use to short periods.

Authors+Show Affiliations

Creighton University School of Medicine, Omaha, Nebraska, USA.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

12387436

Citation

Bhatia, Subhash C., and Shashi K. Bhatia. "Diagnosis and Treatment of Premenstrual Dysphoric Disorder." American Family Physician, vol. 66, no. 7, 2002, pp. 1239-48.
Bhatia SC, Bhatia SK. Diagnosis and treatment of premenstrual dysphoric disorder. Am Fam Physician. 2002;66(7):1239-48.
Bhatia, S. C., & Bhatia, S. K. (2002). Diagnosis and treatment of premenstrual dysphoric disorder. American Family Physician, 66(7), 1239-48.
Bhatia SC, Bhatia SK. Diagnosis and Treatment of Premenstrual Dysphoric Disorder. Am Fam Physician. 2002 Oct 1;66(7):1239-48. PubMed PMID: 12387436.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnosis and treatment of premenstrual dysphoric disorder. AU - Bhatia,Subhash C, AU - Bhatia,Shashi K, PY - 2002/10/22/pubmed PY - 2002/11/26/medline PY - 2002/10/22/entrez SP - 1239 EP - 48 JF - American family physician JO - Am Fam Physician VL - 66 IS - 7 N2 - From 2 to 10 percent of women of reproductive age have severe distress and dysfunction caused by premenstrual dysphoric disorder, a severe form of premenstrual syndrome. Current research implicates mechanisms of serotonin as relevant to etiology and treatment. Patients with mild to moderate symptoms of premenstrual syndrome may benefit from nonpharmacologic interventions such as education about the disorder, lifestyle changes, and nutritional adjustments. However, patients with premenstrual dysphoric disorder and those who fail to respond to more conservative measures may also require pharmacologic management, typically beginning with a selective serotonin reuptake inhibitor. This drug class seems to reduce emotional, cognitive-behavioral, and physical symptoms, and improve psychosocial functioning. Serotoninergic antidepressants such as fluoxetine, citalopram, sertraline, and clomipramine are effective when used intermittently during the luteal phase of the menstrual cycle. Treatment strategies specific to the luteal phase may reduce cost, long-term side effects, and risk of discontinuation syndrome. Patients who do not respond to a serotoninergic antidepressant may be treated with another selective serotonin reuptake inhibitor. Low-dose alprazolam, administered intermittently during the luteal phase, may be considered as a second-line treatment. A therapeutic trial with a gonadotropin-releasing hormone agonist or danazol may be considered when other treatments are ineffective. However, the risk of serious side effects and the cost of these medications limit their use to short periods. SN - 0002-838X UR - https://www.unboundmedicine.com/medline/citation/12387436/Diagnosis_and_treatment_of_premenstrual_dysphoric_disorder_ L2 - http://www.aafp.org/link_out?pmid=12387436 DB - PRIME DP - Unbound Medicine ER -