A pilot study of the effectiveness of citalopram in patients with premenstrual syndrome with prior selective serotonin reuptake inhibitor treatment failure

Abstract

Premenstrual syndrome (PMS) is a chronic mood disorder experienced by reproductive-aged women. Evidence suggests that the selective serotonin reuptake inhibitors (SSRIs) effectively reduce PMS symptoms. A randomized, placebo-controlled study of citalopram (CIT), the most selective SSRI, demonstrated that intermittent dosing (luteal phase) significantly reduced PMS symptoms. Objective: This study examined the effectiveness of CIT in patients with PMS who did not respond to previous SSRIs. Methods: Sixteen women (10 intermittent, 6 daily) with no symptom improvement after two menstrual cycles on an SSRI were given open-label CIT (20–40 mg/day). Scores on the 17-item daily symptom report (DSR) and for each of 5 symptom clusters measured CIT efficacy. Intermittent and daily dosing scores were compared. Results: Baseline DSR scores were significantly improved ( P = 0.02) in both groups, with no difference between the intermittent and daily dosing groups. Clinical improvement (≥50% decrease in DSR) was reported by 80% and 66% of the intermittent and daily dosing groups, respectively. Symptoms were reduced to postmenstrual levels in 60% of the intermittent dosing group. Mood ( P = 0.01) and appetite ( P = 0.01) improved significantly. Function and pain also improved. Conclusion: Citalopram significantly reduced PMS symptoms in patients who failed previous SSRI treatment. These data suggest that intermittent CIT dosing is effective in the treatment of PMS.