Selective serotonin reuptake inhibitors and serotonin and noradrenaline reuptake inhibitors for premenstrual syndrome

Selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs) are effective treatment for the physical and psychological symptoms of PMS. Fluoxetine and sertraline are most commonly used, but other SSRIs and SNRIs are also effective; no one drug is known to be more effective than another.

SSRIs and SNRIs may be used continuously or only during the luteal phase of the menstrual cycle (the 2 weeks before menstruation). Luteal-phase use may have fewer adverse effects and be more acceptable to patients than continuous dosing. However, if the pattern of symptoms suggests premenstrual exacerbation of comorbid depression or anxiety, continuous use is recommended.

See Major depression for advice on doses of SSRIs and SNRIs. Review treatment and symptoms after 1 cycle, or earlier if required. Also review the need for continuing treatment after 12 months. Symptoms usually recur after stopping treatment, and these drugs may be required long term.