Selective serotonin reuptake inhibitors for premenstrual syndrome and premenstrual dysphoric disorder: a meta-analysis

Abstract

Objective: To systematically review evidence of the treatment benefits of selective serotonin reuptake inhibitors (SSRIs) for symptoms related to severe premenstrual syndrome (PMS) and premenstrual dysphoric disorder.

Data sources: We conducted electronic database searches of MEDLINE, Web of Science, Cochrane Library, Embase, PsycINFO, and Cinahl through March 2007, and hand-searched reference lists and pertinent journals.

Methods of study selection: Studies included in the review were double-blind, randomized, controlled trials comparing an SSRI with placebo that reported a change in a validated score of premenstrual symptomatology. Studies had to report follow-up for any duration longer than one menstrual cycle among premenopausal women who met clinical diagnostic criteria for PMS or premenstrual dysphoric disorder. From 2,132 citations identified, we pooled results from 29 studies (in 19 citations) using random-effects meta-analyses and present results as odds ratios (ORs).

Tabulation, integration, and results: Our meta- analysis, which included 2,964 women, demonstrates that SSRIs are effective for treating PMS and premenstrual dysphoric disorder (OR 0.40, 95% confidence interval [CI] 0.31-0.51). Intermittent dosing regimens were found to be less effective (OR 0.55, 95% CI 0.45-0.68) than continuous dosing regimens (OR 0.28, 95% CI 0.18-0.42). No SSRI was demonstrably better than another. The choice of outcome measurement instrument was associated with effect size estimates. The overall effect size is smaller than reported previously.

Conclusion: Selective serotonin reuptake inhibitors were found to be effective in treating premenstrual symptoms, with continuous dosing regimens favored for effectiveness.

Appendix 2

Flow diagram of search and selection processes. Online appendix to Shah N, Jones JB, Aperi J, Shemtov R, Karne A, Borenstein J. Selective reuptake inhibitors for premenstrual syndrome and premenstrual dysphoric disorder: A Meta-Analysis. Obstet Gynecol 2008;111:1175-82.

Fig. 1

Filled funnel plot with pseudo 95% confidence limits for publication bias. Shah. SSRIs for PMS and Premenstrual Dysphoria. Obstet Gynecol 2008.

Fig. 2

Pooling of 29 studies favors treatment with selective serotonin reuptake inhibitors over placebo control for premenstrual syndrome and premenstrual dysphoric disorder. The pooled effect size (standardized mean difference) of -0.50 (-0.64 to -0.37) corresponds to an odds ratio of 0.40 (95% CI 0.31-0.51). ES, effect size. Shah. SSRIs for PMS and Premenstrual Dysphoria. Obstet Gynecol 2008.

Fig. 3

The pooled effect size (standardized mean difference) for studies of premenstrual syndrome is -0.53 (95% CI -0.83 to -0.23), which corresponds to an odds ratio of 0.38 (95% CI 0.22-0.66). The pooled effect size (standardized mean difference) for studies of premenstrual dysphoric disorder is -0.51 (95% CI -0.66 to -0.35), which corresponds to an odds ratio of 0.40 (95% CI 0.30-0.53). PMDD, premenstrual dysphoric disorder; PMS, premenstrual syndrome. Shah. SSRIs for PMS and Premenstrual Dysphoria. Obstet Gynecol 2008.