A 28-year-old woman with premenstrual dysphoric disorder is prescribed an SSRI. She is concerned about taking medication every day and asks whether there is an alternative schedule. What is the correct advice regarding SSRI administration in PMDD?
- A SSRIs are equally effective when taken only during the luteal phase, starting 10 to 14 days before menses ✓
- B SSRIs must always be given continuously throughout the cycle; intermittent use causes rebound symptoms
- C SSRIs should be taken only on the first 3 days of menstruation for maximum benefit
- D SSRIs must be stopped 5 days before menses and restarted after ovulation
Correct answer: A. SSRIs are equally effective when taken only during the luteal phase, starting 10 to 14 days before menses
Explanation
In PMDD, unlike most depressive disorders, SSRIs show rapid onset of effect, so intermittent dosing restricted to the luteal phase (starting around ovulation or 10 to 14 days before menses) is as effective as continuous dosing and reduces drug exposure and side effects. This rapid response reflects modulation of the GABAergic neurosteroid system rather than slow receptor downregulation. Option B is wrong because it applies chronic-depression pharmacokinetics to PMDD; option C targets the wrong phase entirely.
Reference: Kaplan and Sadock's Synopsis of Psychiatry, 12th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.