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Short Onset of Action of a Serotonin Reuptake Inhibitor When Used to Reduce Premenstrual Irritability.

Journal article
Authors Mikael Landén
Helena Erlandsson
Finn Bengtsson
Björn Andersch
Elias Eriksson
Published in Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology
Volume 34
Issue 3
Pages 585-92
ISSN 0893-133X
Publication year 2009
Published at Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry
Institute of Neuroscience and Physiology, Department of Pharmacology
Institute of Clinical Sciences
Pages 585-92
Language en
Keywords Irritability, premenstrual syndrome, premenstrual dysphoric disorder, serotonin reuptake inhibitor, paroxetine
Subject categories Pharmacology and Toxicology, Psychiatry


Several studies suggest that serotonin reuptake inhibitors (SRIs) exert a more rapid effect when used for the treatment of symptoms such as anger and irritability then when used for depression, obsessive-compulsive disorder, or anxiety. In line with this, premenstrual irritability can be effectively dampened by intermittent administration of an SRI, from ovulation to menstruation, indicating an onset of action of 10 days or less. How fast this effect appears, in terms of hours or days, is of considerable theoretical interest, but has previously not been studied in detail. To explore this issue, 22 women with marked premenstrual irritability, who previously had responded to paroxetine, were given this compound during two menstrual cycles and placebo during one cycle in a double-blind, cross-over fashion. The women were asked to start medication in the midst of the luteal phase when irritability had been intense for 2 days. The paroxetine cycles differed significantly from the placebo cycle as early as 14 h after drug intake with respect to the number of subjects experiencing sustained reduction in irritability. When the different cycles were compared with respect to irritability-rating scores for each time of assessment, the difference was significant at day 3. The side effect nausea had an even more rapid onset (4 h), but usually disappeared within 4 days. To summarize, this controlled trial shows that an SRI reduces premenstrual irritability already within a few days after the onset of treatment.Neuropsychopharmacology advance online publication, 2 July 2008; doi:10.1038/npp.2008.86.

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