Medicine 1: Selective Serotonin Reuptake Inhibitors

Please consult a doctor to get medical prescription before administering the solutions.

What is it?

Selective serotonin reuptake inhibitors (SSRIs) are anti-depressants that have been successful in reducing mood symptoms. As the first-line of defence, SSRIs are the gold standard in PMDD treatment, and for good reason.

They’re the first option recommended by most clinicians to ease both emotional and physical symptoms of PMDD. Well-known SSRIs include:

• Fluoxetine (Prozac)

• Paroxetine (Paxil, Pexeva)

• Sertraline (Zoloft)¹

• Citalopram (Cipramil)

• Escitalopram (Cipralex)

Important: Bupropion, a commonly prescribed antidepressant, is not effective for PMDD.

How does it work?

These medications increase the concentration of a neurotransmitter (chemical messenger) in the brain called serotonin, which is thought to have a good influence on mood, emotion and sleep. After carrying a message, serotonin is usually reabsorbed by the nerve cells (known as 'reuptake'). SSRIs work by blocking ('inhibiting') reuptake, meaning more serotonin is available to pass further messages between nearby nerve cells.

SSRIs can be taken continuously or only during the luteal phase (roughly two weeks before your period). However, you must take them for at least three months before they start working. They weren't found to be more effective when taken continuously rather than only during the second half of the cycle.

What is the efficacy?

Electronic searches for relevant randomized controlled trials (RCTs) were undertaken. Thirty-one RCTs were included in the review. They compared fluoxetine, paroxetine, sertraline, escitalopram and citalopram versus placebo. SSRIs reduced overall self-rated symptoms significantly more effectively than placebo.

Conclusion: SSRIs are effective in reducing the symptoms of PMS, whether taken in the luteal phase only or continuously. Adverse effects are relatively frequent, the most common being nausea and asthenia. Adverse effects are dose-dependent².

What are the side effects?

It's important for women who are considering taking antidepressants to know what side effects they could have. SSRIs can cause things like nausea, sleep problems, and decreased libido³.

1. Short-term effects: Nausea, decreased energy, drowsiness, fatigue, sweating.

2. Long-term effects: Sexual disturbances or dysfunctions, sleep disturbance, weight gain⁴.

References

1. Chu A, Wadhwa R. Selective Serotonin Reuptake Inhibitors [Internet]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025 Jan– [cited 2025 Apr 23]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554406/

2. Marjoribanks J, Brown J, O'Brien PMS, Wyatt K. Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database Syst Rev. 2013 Jun 7;2013(6):CD001396. doi:10.1002/14651858.CD001396.pub3.

3. Institute for Quality and Efficiency in Health Care (IQWiG). Premenstrual syndrome: Learn more – Treatment for PMS [Internet]. Cologne (DE): IQWiG; 2022 May 18 [cited 2025 Apr 23]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279264/

1. Ferguson JM. SSRI antidepressant medications: adverse effects and tolerability. Prim Care Companion J Clin Psychiatry. 2001;3(1):22–7. doi: 10.4088/pcc.v03n0105.