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  1. Treatments
  2. Medicines (Pharmalogical)

Medicine 2: Serotonin-Norepinephrine Reuptake Inhibitors

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

What is it?

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) are considered a second-line option when selective serotonin reuptake inhibitors (SSRIs) are not tolerated well or fail to provide adequate relief to the individual suffering from PMDD.

SNRIs are a class of antidepressants that may be prescribed when PMDD symptoms are especially mood-heavy, such as persistent irritability, sadness, or emotional volatility.

Although not officially approved for PMDD, the following drug is often recommended when symptoms are especially mood-centred:

  • Venlafaxine (Effexor, Effexor XR)

Venlafaxine is the most studied SNRI. It is often used off-label for this condition.

How does it work?

SNRIs work similarly to SSRIs, but with a broader effect. They increase the levels of both serotonin and norepinephrine, the two neurotransmitters (or chemical messengers in your brain) that are responsible for regulating mood, focus, and energy levels.

After carrying a message, serotonin and norepinephrine are usually reabsorbed by the nerve cells (known as 'reuptake'). SNRIs work by blocking ('inhibiting') this reuptake, which means more serotonin and norepinephrine are available to pass further messages between nearby nerve cells. Aka more of these 'feel-good' chemicals remain active in the brain, alleviating emotional and psychological symptoms of PMDD.

Most patients report noticeable improvements within 3 to 4 weeks of starting treatment1, and the benefits tend to sustain across menstrual cycles with regular use.

What is the efficacy?

Although research is limited compared to SSRIs, preliminary studies and clinical experience show that Venlafaxine is effective in reducing PMDD-related mood symptoms1. It may be particularly helpful in individuals who don’t respond fully to SSRIs or who experience significant anxiety, agitation, or depressive symptoms. However, more large-scale studies are needed to confirm long-term efficacy.

What are the side effects?

Like SSRIs, SNRIs come with potential side effects. These can vary from person to person and may ease over time. According to the NHS, these include:

  1. Short-term effects: Nausea, sweating, headaches, dry mouth, insomnia, drowsiness, constipation.

  2. Long-term effects: Sexual dysfunction, increased blood pressure, weight changes, period changes (heavy bleeding, spotting, or bleeding between periods).

It’s important to start with a low dose and monitor how your body responds. Any changes should always be made under medical supervision.

References
  1. Hsiao MC, Liu CY. Effective open-label treatment of premenstrual dysphoric disorder with venlafaxine. Psychiatry and Clinical Neurosciences. 2003;57(3): 317-321.

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