A 27-year-old woman reports marked irritability, labile mood, bloating, breast tenderness, and difficulty concentrating beginning predictably 5 days before menstruation and resolving within 2 to 3 days of onset of flow. Symptoms recur in most cycles over the past year and impair her work. Which treatment approach has evidence for this condition?

• A Continuous combined oral contraceptive pills alone
• B Tricyclic antidepressant taken only after menses begin
• C Lithium prophylaxis started mid-cycle
• D Fluoxetine given continuously or only during the luteal phase ✓

Explanation

This is premenstrual dysphoric disorder, defined by affective and somatic symptoms confined to the luteal phase with remission shortly after menses onset across most cycles causing functional impairment. SSRIs, particularly fluoxetine, are first-line and uniquely among psychiatric drugs are effective even with luteal-phase-only (intermittent) dosing. Lithium has no role, tricyclics lack efficacy data here, and plain combined pills address somatic symptoms less reliably than SSRI therapy for the affective component.

Reference: Kaplan and Sadock's Synopsis of Psychiatry, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.