Antidepressants are the big guns of PMS medications: they are powerful drugs that are effective in reducing mood symptoms for women with severe PMS and PMDD. The two major types of antidepressants are selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants.

SSRIs

SSRIs are the preferred treatment for severe PMS. They alleviate not only PMS-related mood symptoms, but they often help the physical symptoms as well. The main SSRIs used to treat PMS symptoms are fluoxetine, sertraline, and paroxetine.

Common side effects of SSRIs include nervousness, restlessness, nausea, diarrhea, and sexual problems. They may also cause appetite or weight gain.

Another problem is the SSRIs discontinuation syndrome, in suddenly discontinuing an SSRI can lead to physical and psychological withdrawal symptoms. Women who try an SSRI in response emotional crisis and want to stop the drug may find that withdrawal is more difficult than they anticipated.

These drugs are also known to cause sexual dysfunction as a loss of libido and the inability to orgasm. In 2004, the Center the Evaluation of Risk to Human Reproduction, part of the National Institutes of Health, released a report that stated that fluoxetine not only toxic to the fetus of a pregnant women, but that it also “reproductive toxicity” because of its effect on sexual function. drug may change the length of the menstrual cycle.

SSRIs take anywhere from a few days to six weeks to effective. There's also a degree of fine-tuning involved: you and doctor may have to work out the days in which you should medication to get the best results. Once you stop taking takes several days for them to leave your system completely.

Tricyclic Antidepressants

Tricyclic antidepressants were more commonly used SSRIs were introduced. They work by increasing norepinephrine serotonin levels in the brain. In contrast, SSRIs let the brain use more efficiently. Tricyclics also interfere with other neurotransmitter systems and brain cell receptors, causing a variety effects, which makes them less desirable depression treatments.

Fluoxetine

In 1988 Eli Lilly introduced fluoxetine in the United States under the brand name Prozac, but when the manufacturer lost a patent dispute in 1991, other drug companies began making the drug. Fluoxetine is used to treat depression, premenstrual dysphoric disorder (PMDD), panic disorder, obsessive-compulsive disorder, and bulimia.

Some doctors also use it to treat attention–deficit hyperactivity disorder (ADHD), anorexia nervosa, and a host of other conditions, although the drug hasn't been officially approved to treat them.

Fluoxetine is has a strong energizing effective, which is why it such an effective treatment for depression and other mood disorders. Fluoxetine is sold under the brand name Sarafem to treat PMDD. Chapter 11 provides an overview of the controversy surrounding the use of fluoxetine to treat PMDD.

Sertraline

Sold under the brand name Zoloft, sertraline is another SSRI used to treat severe PMS symptoms. A 2002 study, funded by Pfizer, the maker of Zoloft, followed 281 women who received doses either 50 or 100 milligrams of sertraline or a placebo during the luteal phase for three menstrual cycles. The drug was found to improve PMDD symptoms, quality of life, the ability to function, and social adjustment.

Sertraline may also be associated with lower health-care costs compared to other SSRIs, according to a 2001 presentation by PMDD expert Jean Endicott, Ph.D., at the annual meeting of the American Psychiatric Association.

Paroxetine

Paroxetine is the third SSRI approved for treating PMDD. It's also approved to treat depression, obsessive-compulsive disorder, post traumatic stress disorder, generalized anxiety disorder, and social anxiety disorder. A 2004 study published in the journal Psychosomatic Medicine demonstrated that intermittent dosing of paroxetine relieved PMDD-related mood symptoms.

Paroxetine is sold as Paxil CR (controlled release) and is available in doses from 12.5 to 37.5 milligrams.