Selections from current literature. Treatments for premenstrual dysphoric disorder.

Premenstrual syndrome (PMS) is a regularly recurring cluster of mood and somatic symptoms, occurring during the luteal phase of the menstrual cycle. According to the American College of Obstetricians and Gynecologists, 20–40% of women have some premenstrual symptoms.1 In ~5% of women of reproductive age, the symptoms are severe enough to seriously disrupt their lives and relationships,2 thereby meeting the DSM-IV criteria for premenstrual dysphoric disorder (PMDD). Despite the prevalence of PMDD, its cause is uncertain. Nutritional, hormonal and neurotransmitter imbalances have all been implicated. Because of the substantial placebo response in this disorder,3 uncontrolled studies have led to an abundance of claims for treatments that have not been substantiated. Some controlled studies have shown benzodiazepines to be effective4 but, because of the side effects and risks of addiction and abuse, many physicians are reluctant to prescribe them. Surgical or medical induction of an anovulatory state is also effective,5,6 but the resultant low oestrogen state can increase the risks for cardiac disease and osteoporosis. Following is a discussion of several placebo-controlled, double-blinded studies of other therapies which appear to be promising. They include continuous and intermittent use of selective serotonin re-uptake inhibitors (SSRIs), calcium supplementation and chaste berry extract.