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SSRIs, birth control, exercise effective for menstrual mood disorders
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SAN ANTONIO — Marlene P. Freeman, MD, of Harvard Medical School and Massachusetts General Hospital, reviewed evidence for pharmacological and non-pharmacological treatments for premenstrual dysphoric disorder and related conditions in a session here at U.S. Psychiatric and Mental Health Congress.
Premenstrual mood problems and risk factors initially present in late 20s to mid-30s, Freeman said.
Individuals with a history of major depression, postpartum mood episodes and bipolar disorder have higher risk for premenstrual dysphoric disorder (PMDD).
There is strong evidence that selective serotonin reuptake inhibitors (SSRIs) are effective for PMDD and related disorders.
“What’s so interesting about antidepressants to treat PMDD is that we really have a choice in terms of how to dose,” Freeman said. “Some individuals may be taking continuous SSRIs; some may use intermittent dosing. For someone who may have a shorter duration of symptoms may be able to take antidepressants just one week before onset of their menstrual cycle.”
There has not been much evidence regarding hormonal birth control for PMDD until recently, Freeman said. However, recent reviews and meta-analyses indicated birth control had similar efficacy to antidepressants for PMDD.
“Since individuals can have such different responses to hormonal birth control, there hasn’t been very clear literature [evidence] until more recently. Now some companies have specifically looked at combination birth control pills for the treatment of PMDD,” Freeman said.
Non-pharmacological treatments for PMDD include light therapy, exercise, omega-3 fatty acids, calcium and diet.
There are limited data on light therapy, although a reduction in depressive symptoms in PMDD was reported, she said.
Although exercise is frequently recommended in combination with other PMDD treatments, no adequately powered findings exist, Freeman said.
“In general, we do make exercise part of the treatment plan for almost every patient that would come in,” she said. “There are very well-documented positive mood benefits and health benefits of exercise. But really, exercise is difficult to study, so that may be why we don’t have a lot of systematic study in premenstrual symptoms or PMDD.”
Calcium has the largest evidence base for PMDD, although its benefits are unclear, she said.
Omega-3 and omega-6 fatty acids and diet have not been broadly studied for PMDD.
“PMDD is a diagnosis that is so interesting because of the temporal relationship to the menstrual cycle, which I also think makes the tracking so helpful for patients,” Freeman said. “It’s something we have to treat individually in terms of what treatments to start with and what we may need to add on.” – by Amanda Oldt
Reference:
Freeman MP, et al. Menopausal depression and PMDD. Presented at: U.S. Psychiatric and Mental Health Congress; Oct. 21-24, 2016; San Antonio.
Disclosures: Freeman reports receiving research support from Takeda and JayMac Pharmaceuticals; serving on advisory boards for Takeda/Lundbeck, Sunovion, JDS Therapeutics, and SAGE; serving as consultant for JDS Therapeutics; serving on an Independent Data Safety and Monitoring Committee for Janssen/Johnson & Johnson; and receiving CME/honorarium from GOED newsletter.