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Luteal Phase and Symptom-Onset Dosing of SSRIs/SNRIs in the Treatment of Premenstrual Dysphoria: Clinical Evidence and Rationale

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Abstract

Premenstrual dysphoria (PMD) affects 3–8 % of women in their reproductive years worldwide. This paper summarizes the studies establishing the efficacy of continuous, luteal phase, and symptom-onset dosing of selective serotonin reuptake inhibitors (SSRIs) and dual serotonin and norepinephrine reuptake inhibitors (SNRIs) in treating women with PMD. The evidence indicates that for some women, symptom-onset dosing with escitalopram, fluoxetine, and paroxetine controlled release (CR) is as effective as continuous or luteal phase dosing. The wide range of clinical efficacy of SSRIs/SNRIs suggests that they exert their therapeutic effect through multiple pathways. This paper offers a few alternative mechanisms of action to explain the rapid response to SSRIs/SNRIs in women with PMD.

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Acknowledgments

MS has received research grants/funding from Canadian Institutes of Health Research, Ontario Mental Health Foundation, Natural Sciences and Engineering Research Council of Canada, Society for Women’s Health Research, Pfizer, Eli Lilly, and Lundbeck; has served as a consultant for AstraZeneca, Bayer Canada, Servier, and Lundbeck; and has received honoraria from the Society for Women’s Health Research and AstraZeneca. However, no sources of funding have been used to prepare this manuscript.

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The authors declare no conflicts of interest related to this manuscript.

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  1. Women’s Health Concerns Clinic, St. Joseph’s Healthcare, 301 James Street South, Hamilton, ON, L8P 3B6, Canada

    Meir Steiner & Tina Li

  2. Departments of Psychiatry and Behavioural Neurosciences and Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada

    Meir Steiner

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Correspondence to Meir Steiner.

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Steiner, M., Li, T. Luteal Phase and Symptom-Onset Dosing of SSRIs/SNRIs in the Treatment of Premenstrual Dysphoria: Clinical Evidence and Rationale. CNS Drugs 27, 583–589 (2013). https://doi.org/10.1007/s40263-013-0069-7

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