Do you have any personal experience with Prozac used to treat PMDD? If so, will you please share how that went?

(If I don’t know what PMDD is, should I not answer?)

If it is what I think it is, pre-menstrual depression, I have heard that it can be an effective treatment for these symptoms. I don’t have personal experience of it though.

PMDD

So it was what I guessed, but thanks for the confirming link.

Since Prozac takes weeks of daily use to reach a stable therapeutic level in a person’s system, it seems that your doctor may be misinformed about the appropriateness of this prescription. While we can take a painkiller when we have a headache, taking Prozac only when you are dysphoric may be little more than a placebo treatment.

This is from the NIH website:

“The effectiveness of fluoxetine for the treatment of PMDD was established in 3 placebo-controlled trials (1 intermittent and 2 continuous dosing). In an intermittent dosing trial described below, patients met Diagnostic and Statistical Manual-4th edition (DSM-IV) criteria for PMDD. In the continuous dosing trials described below, patients met Diagnostic and Statistical Manual-3rd edition revised (DSM-IIIR) criteria for Late Luteal Phase Dysphoric Disorder (LLPDD), the clinical entity now referred to as PMDD in the DSM-IV. Patients on oral contraceptives were excluded from these trials; therefore, the efficacy of fluoxetine in combination with oral contraceptives for the treatment of PMDD is unknown.

In an intermittent dosing double-blind, parallel group study of 3 months duration, patients (N = 260 randomized) were treated with fluoxetine 10 mg/day, fluoxetine 20 mg/day, or placebo. Fluoxetine or placebo was started 14 days prior to the anticipated onset of menstruation and was continued through the first full day of menses. Efficacy was assessed with the Daily Record of Severity of Problems (DRSP), a patient-rated instrument that mirrors the diagnostic criteria for PMDD as identified in the DSM-IV, and includes assessments for mood, physical symptoms, and other symptoms. Fluoxetine 20 mg/day was shown to be significantly more effective than placebo as measured by the DRSP total score. Fluoxetine 10 mg/day was not shown to be significantly more effective than placebo on this outcome. The average DRSP total score decreased 38% on fluoxetine 20 mg/day, 35% on fluoxetine 10 mg/day, and 30% on placebo.” Link

It does go on to say that continuous dosing also worked. @Dr_Lawrence , if you come back to this, can you tell me what a VAS (Visual Analogue Scale) is? And why would that be used in the continuous dosing study, but the Daily Record was used in the intermittent dosing study? Why wouldn’t they use the same way of judging effectiveness in both studies?

I’m a GYN nurse practitioner and cyclical SSRIs are a recognized and research supported treatment for PMS/PMDD. Prozac was the first one used this way, and was actually marketed under the brand name Sarafem for this purpose. I’ve had success using other SSRIs like Zoloft in this way too.

Some of my patients find that it works well for them, while others end up deciding that they need some help throughout the month and switch to daily dosing. And of course, others don’t get the hoped-for benefits at all.

A VAS asks the patients to mark a point on a line that coincides with their answer.

Different researchers are free to use different measurement techniques.