Don't Stop
A significant number of women who suffer from severe premenstrual symptoms, around half, have found relief with the antidepressant known as sertraline. However, women tend to relapse somewhere between 6-8 months after they stop taking the medication. The relapse is more pronounced in those who took the medication for only a short period as well as for those with very severe premenstrual symptoms.
Premenstrual syndrome (PMS) is quite common in women who menstruate. Many antidepressant medications, including the above mentioned sertraline hydrochloride, have been granted approval as treatments for the more severe type of PMS, which is known as premenstrual dysphoric disorder (PMDD). "There is little information about the optimal duration of treatment, although anecdotal reports and small pilot investigations suggest that premenstrual symptoms return rapidly in the absence of effective medication," say the authors of the new study.
A team at the University of Pennsylvania School of Medicine in Philadelphia, headed by Ellen W. Freeman, Ph.D., studied 174 women suffering from PMS and PMDD over the course of an 18-month period. The female participants were placed in two groups, which received either a long-term or a short-term course of treatment. 87 women were treated with sertraline for four months and were then placed on a placebo for the next 14 months. The other 87 women were treated with sertraline for 12 months after which they received a placebo for six months.
Most Improved
The vast majority of the women reported an improvement in their symptoms: 125 out of 174 patients, or 72%. The improvement was experienced by most during the first four months. Of those women taking the long-term treatment, relapse was seen in 41% of the women. Relapse was defined as returning to the same level of symptoms as experienced prior to treatment. The average time for relapse to occur was at 8 months in the long-term treatment group. Of those women in the short-term treatment group, 60% relapsed at around 4 months.
Severe Symptoms
"Patients with severe symptoms at baseline were more likely to experience relapse compared with patients in the lower symptom severity group and were more likely to experience relapse with short-term treatment," said the authors. "Duration of treatment did not affect relapse in patients in the lower symptom severity group."
The researchers found that the 41% of patients who experienced a complete recovery from premenstrual symptoms at four months had the lowest risk for relapse. The authors feel that clinicians must work toward finding the proper balance in terms of how long to administer the medication in order to achieve a satisfactory response while minimizing the risk for relapse after the medication is discontinued.
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