If your PMDD feels like someone flips a switch 7–10 days before your period and suddenly you’re raging/crying/hate-everyone-and-their-dishes, you’re not imagining it. That luteal-phase mood crash is exactly the pattern SSRIs were studied for, and it’s why the big medical orgs (like ACOG) name SSRIs as a first-line treatment for PMDD. ACOG+2Lippincott Journals+2
With that being said, SSRI don't work for everyone. Many people use other methods to help treat their PMDD symptoms.
What is PMDD?
Premenstrual Dysphoric Disorder (PMDD) is a hormone-triggered mood disorder where symptoms ramp up like a hurricane in the two weeks before your period. The "storm" then eases a few days after bleeding starts. Not to be dramatic, but the PMDD experience is like PMS on rageful crack, with the volume of life turned all the way up on high resulting in irritability, rage, anxiety, depression, brain fog, and sensory overwhelm that actually get in the way of your entire existence.
Why SSRIs Are Used for PMDD
SSRIs (selective serotonin reuptake inhibitors) are antidepressants, but in PMDD they’re used because PMDD brains are extra sensitive to normal hormone shifts and serotonin is part of that pathway. When estrogen/progesterone wobble after ovulation, serotonin takes a hit, and mood tanks. SSRIs help stabilize that component of PMDD. That’s why guidelines say suggest ssri options to help treat pmdd. The other side of that coin though, is that there's so much more to PMDD than serotonin and that's why they don't work for everybody.
The Cool Part: You Don’t Always Have to Take Them All Month
This is the PMDD-specific part everyone loves.
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Daily/continuous – take it every day of the month.
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Luteal-phase only – take it just in the 2 weeks before your period (after ovulation) and stop when bleeding starts.
Which SSRIs Are Used?
Most of the research is on:
Fluoxetine - Sertraline - Paroxetine CR
Your doctor usually chooses which med you take for PMDD symptoms depending on any other meds you may be taking, side effects that you experience, co-existing conditions that you may have, and insurance.
What Symptoms Do SSRIs Help Most?
Rage/irritability (the “I need to move out and live in the woods” week)
Depression/hopelessness
Anxiety/tension
Emotional sensitivity / rejection sensitivity
accpjournals.onlinelibrary.wiley.com
How Fast Do They Work?
Faster than in depression. Some PMDD patients can feel a difference the same cycle JAMA Network
Side Effects to Watch For
Nausea or GI upset in the first days
Headache
Sleep changes (sleepier or more alert)
Lower libido / sexual side effects
With paroxetine: more chance of withdrawal if you stop suddenly
Mood swings
Numbness
What If It Doesn’t Work?
other methods can be used to help pmdd symptoms. If you'd like a link to that article, use the green chat button in the bottom right hand side and we can send it to you.
Safety & Suicidality Note
People with PMDD have higher rates of suicidal thoughts and behaviors than the general population, so every med plan should include a safety plan and follow-up, especially in the luteal phase. If symptoms get darker when you start or change a dose, please call your prescriber right away. Medscape
Personal experience with SSRI varies from person to person. I unfortunately am one of the ones that SSRIs did not help. In the beginning. I noticed I was a little less anxious which was nice, but soon, things took a much darker turn. Soon, I couldn't feel joy, happiness, or love.
