This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Selective serotonin reuptake inhibitors and PMS

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Serotonin specific reuptake inhibitors are effective in reducing the physical and psychological symptoms of the premenstrual syndrome (1).

  • recommended as a first line agent in the treatment of severe PMS
  • treatment should be managed by psychiatrics or GP’s with a special interest
  • can be used as either continuous dosing or just during the luteal phase
    • use of newer SSRIs, such as citalopram, may produce resolution of symptoms where other SSRIs have failed (1)
    • severe PMS also improves significantly with either luteal-phase or symptom-onset dosing of escitalopram with good tolerability (1)

  • if used on continuous basis withdrawal of the SSRI therapy should be done gradually to minimize withdrawal symptoms

  • women should be informed about possible side effects such as nausea, insomnia and reduction in libido

  • women should be provided with prepregnancy counselling at every opportunity. They should be informed that PMS symptoms will abate during pregnancy and SSRIs should therefore be discontinued safely prior to and during pregnancy
    • women with PMS who become pregnant while taking an SSRI/SNRI should be aware of any possible association with congenital malformations
      • there has been data to support an association between the maternal use of SSRIs in late pregnancy and persistent pulmonary hypertension of the newborn in the offspring (2)
        • MHRA advice suggests that epidemiological data suggest that the use of SSRIs in pregnancy, particularly in the later stages, may increase the risk of persistent pulmonary hypertension in the newborn. Healthcare professionals are encouraged to enquire about the use of SSRIs and SNRIs, particularly in women in the later stages of pregnancy. Close observation of neonates exposed to SSRIs or SNRIs for signs of PPHN is recommended after birth (3)
      • a retrospective epidemiological study has suggested that the use of paroxetine during the first trimester of pregnancy may be associated with an increased incidence of birth abnormalities compared to use of other antidepressants (4). The types of abnormalities seen were reflective of those seen in the general population. The most common birth abnormalities seen were cardiovascular (of which the most common were ventral septal defects)

      • the BJOG review states that published data are conflicting and it is still possible that SSRI or SNRI use in very early pregnancy may be associated with a small increased risk of congenital malformations (1)
        • a study by Furu et al points against a substantial teratogenic risk associated with exposure to these drugs during the first trimester, and suggests that the reported risk is driven by yet to be determined confounding factors. In addition, women with PMS are likely to discontinue treatment soon after the first missed period rather than later in the first trimester and therefore the risk may be further diminished

  • there are also data supporting the use of serotonin–noradrenaline reuptake inhibitors (SNRIs) for premenstrual dysphoric disorders

  • currently, most SSRIs are licensed in the USA for PMDD, but not in the UK. (1).

Tricyclic antidepressants are no more effective than placebo in most studies.


Related pages

Create an account to add page annotations

Add information to this page that would be handy to have on hand during a consultation, such as a web address or phone number. This information will always be displayed when you visit this page

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.


Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.