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Citalopram Curbs Severe Premenstrual Syndrome in Patients Failing SSRIs

Preliminary indications are citalopram is effective in women with severe premenstrual syndrome who have not responded to previous treatment with selective serotonin reuptake inhibitors.

Citalopram, the most selective of the selective serotonin reuptake inhibitors (SSRIs), provided significant improvement in clinical symptoms among a small group of these patients in an open-label study in the United States.

An earlier placebo-controlled study of citalopram showed half-cycle dosing (luteal phase) was effective for DSM-IV-defined premenstrual dysphoric disorder (PMDD), a severe form a premenstrual syndrome (PMS).

In this current study, Dr E. W. Freeman and colleagues from the University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, examined the effectiveness of half-cycle dosing of citalopram.

Participants were 17 PMS patients with no improvement in symptoms after two menstrual cycles on an SSRI.

The women were given open-label citalopram (20 mg to 40 mg/day), with 11 receiving half-cycle dosing and six receiving full-cycle dosing.

Researchers used scores on the 17-item daily symptom report (DSR) and on each of five DSR symptom clusters to measure the drug?s efficacy.

In both the half-cycle and full-cycle dosing groups, there were significant improvements in total premenstrual DSR scores (p<0.001). The half-cycle reported lower DSR scores than the full-cycle group. However, the difference did not reach significance in this small sample.

Significant improvement also occurred in all DSR factor scores, including mood, behavioral, pain, physical symptoms and appetite.

Overall, 76 percent of the women reported clinical improvement, with 41 percent experiencing symptom remission (defined as a decrease in symptoms to postmenstrual levels). Clinical improvement was defined as a decrease from DSR baseline scores of half or more.

The results are preliminary but suggest citalopram is effective for PMS patients who have failed previous SSRI treatment, conclude these authors.
J Womens Health Gend Based Med 2002 Jun;11(5):459-64. "Citalopram in PMS Patients with Prior SSRI Treatment Failure: A Preliminary Study."

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