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Placebo-controlled trial comparing intermittent and continuous paroxetine in premenstrual dysphoric disorder.

Journal article
Authors Mikael Landén
Hans Nissbrandt
Christer Allgulander
Karin Sörvik
Christina Ysander
Elias Eriksson
Published in Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology
Volume 32
Issue 1
Pages 153-61
ISSN 0893-133X
Publication year 2007
Published at Institute of Neuroscience and Physiology, Department of Pharmacology
Pages 153-61
Language en
Keywords Adult, Disability Evaluation, Double-Blind Method, Drug Administration Schedule, Female, Humans, Pain Measurement, methods, Paroxetine, therapeutic use, Placebos, Premenstrual Syndrome, drug therapy, psychology, Serotonin Uptake Inhibitors, therapeutic use, Treatment Outcome
Subject categories Physiology


Serotonin reuptake inhibitors (SRIs) do not have to be administered continuously to be effective for premenstrual dysphoric disorder (PMDD), but can be given during luteal phases only. This is of practical importance, but also of theoretical interest since it suggests that the onset of action of SRIs is shorter in PMDD than in, for example depression. In this study, both continuous and intermittent SRI administration was compared with placebo, with the special purpose of analyzing if different PMDD symptoms respond differently depending on the treatment regimen. To this end, women meeting slightly modified DSM-IV criteria for PMDD (mean+/-SD age, 37+/-6.3 years) were treated for three menstrual cycles with paroxetine continuously, paroxetine during the luteal phase only, or placebo, the population completing at least one treatment cycle comprising 55-56 subjects per group. Continuous treatment with paroxetine reduced premenstrual symptoms effectively with a response rate of 85%. The effect size was highest for irritability (1.4) and lowest for lack of energy (0.5). Intermittent treatment was as effective as continuous treatment in reducing irritability, affect lability, and mood swings, but had a somewhat weaker effect on depressed mood and somatic symptoms. The study indicates that the response rate when treating PMDD with SRIs is high, and that irritability is a key target symptom. Symptoms such as irritability, affect lability, and mood swings appear to be more inclined to respond rapidly to SRIs, enabling intermittent treatment, than are, for example, the somatic symptoms.

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