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Selective Serotonin Reuptake Inhibitors (SSRIs) for PMS and PMDD

Examples

Generic Name Brand Name
citalopram Celexa
fluoxetine Prozac, Sarafem
fluvoxamine Luvox
paroxetine Paxil
sertraline Zoloft

How It Works

SSRIs are a type of medicine that can restore the balance of certain brain chemicals called neurotransmitters. This may help relieve physical and emotional symptoms of PMS. SSRIs are also used to treat depression, anxiety, menopause hot flashes, and chronic pain.

Why It Is Used

SSRIs are often the first-choice medicine for treating severe premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) symptoms, including depression, anxiety, irritability, anger, mood swings, breast tenderness, bloating, headache, and joint and muscle pain.

For many women, SSRI medicine need only be taken during the premenstrual phase, generally 2 weeks before the start of menstrual bleeding.

How Well It Works

SSRIs may help relieve the emotional and physical PMS and PMDD symptoms.1 SSRI therapy can bring relief within a few days of starting this medicine.

Side Effects

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after you take the medicine for a while.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call 911 or other emergency services right away if you have:

  • Trouble breathing.
  • Swelling of your face, lips, tongue, or throat.

Call your doctor if you have:

  • Hives.
  • Thoughts of suicide.
  • Agitation and restlessness.
  • Seizures.
  • Fast heartbeat.
  • Nausea and vomiting.

Common side effects of this medicine include:

  • Loss of sexual desire or ability.
  • Irritability.
  • Trouble sleeping or drowsiness.
  • Headache.
  • Changes in appetite.

FDA advisories. The U.S. Food and Drug Administration (FDA) has issued:

  • An advisory on antidepressant medicines and the risk of suicide. Talk to your doctor about these possible side effects and the warning signs of suicide.
  • A warning about taking triptans, used for headaches, with SSRIs (selective serotonin reuptake inhibitors) or SNRIs (selective serotonin/norepinephrine reuptake inhibitors). Taking these medicines together can cause a very rare but serious condition called serotonin syndrome.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

You can take a selective serotonin reuptake inhibitor (SSRI) by mouth every day of the month. Or you can take an SSRI daily between the day you ovulate and the start of your period (usually about 2 weeks).

SSRI treatment is not recommended if you have a seizure disorder or a history of mania (including bipolar disorder). These conditions can be made worse by an SSRI.

SSRIs make bleeding more likely in the upper gastrointestinal tract (stomach and esophagus). Taking SSRIs with NSAIDs (such as Advil or Aleve) makes bleeding even more likely. Taking medicines that control acid in the stomach may help.

As with any medicine, some medicines can adversely interact with an SSRI. Before you try an SSRI, discuss your medicine and dietary supplement use with your doctor.

When you are taking an SSRI continuously, never stop taking it abruptly. The long-term use of an SSRI should be tapered off slowly and only under the supervision of a doctor. Abruptly stopping SSRI medicines can cause flu-like symptoms, headaches, nervousness, anxiety, or insomnia.

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Advice for women

Women who use this medicine during pregnancy have a slightly higher chance of having a baby with birth defects. If you are pregnant or planning to get pregnant, you and your doctor must weigh the risks of using this medicine against the risks of not treating your condition.

Checkups

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Complete the new medication information form (PDF)new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

References

Citations

  1. Kwan I, Onwude JL (2009). Premenstrual syndrome, search date July 2009. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.

Credits

By Healthwise Staff
Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
Specialist Medical Reviewer Kirtly Jones, MD - Obstetrics and Gynecology
Last Revised June 8, 2012

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