A 26-year-old woman meets full DSM-5 criteria for premenstrual dysphoric disorder, with severe mood symptoms confined to the luteal phase. She declines continuous daily medication and wants minimal drug exposure. Which regimen is evidence based?
- A Fluoxetine taken only during the luteal phase, days 15 to 28 of each cycle ✓
- B Amitriptyline taken continuously throughout the cycle
- C Progesterone suppositories during the follicular phase
- D Metformin daily throughout the cycle
Correct answer: A. Fluoxetine taken only during the luteal phase, days 15 to 28 of each cycle
Explanation
Selective serotonin reuptake inhibitors are first line for PMDD, and fluoxetine can be given either continuously or intermittently during the luteal phase only, reducing total exposure while preserving efficacy. Progesterone has not shown benefit over placebo despite the historical theory of progesterone excess. Amitriptyline and metformin have no role in PMDD management.
Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.