Antidepressants only during PMS days?

[nomorespaghetti]

I’ve been struggling with severe PMS since my periods came back after my second child, two years ago. Awful physical and psychological symptoms for half the month

I’ve been taking the combined pill Eloine (also known as Yaz) for 2 months and it’s helped with the physical symptoms, but I’m still getting 7-10 days of irritability, rage, overwhelm, bad sleep…

I want to stay on the pill, but need some extra help I think. The doctor has prescribed 50mg sertraline, she said I could take it continuously, or just on days 15-28. I’m more inclined to take it for just the 10 days before the end of my pill packet.

Has anyone done this and has it been effective?

I’m concerned about side effects, and also stop starting, although I read (albeit on Wikipedia!) that withdrawal syndrome follows continuous use of a month, so presumably I shouldn’t get withdrawn after only a few weeks use each month?

Also interested if anyone has tried pill plus ADs for PMS/PMDD?

Thanks

This doesn't sound wise!

The first few days of starting sertraline can have some awful side effects for some, which usually settle down after 2 weeks.

Surely if you were only doing 2 weeks at a time you would get stuck in a cycle of continuous awful side effects every month?

Well apparently not for PMS, according to my GP, but I’m dubious too!

Hopeful bump!

I'm not sure what the benefit is of stop starting, I thought SSRIs need to achieve a cumulative level in the body to be effective. I could be wrong though.

This does sound strange advice. It isn’t standard. It could make you feel worse.

SSRI’s do need to reach a certain concentration in your body and the uptake if serotonin in the synapses changes. So by stop/ starting you would be triggering all kinds of changes.

This doesn't sound right! Sertraline doesn't work like that. Fucking rubbish Dr.

You can take proprananol like that. Not sertraline or other SSRIs.

Please please get another Dr opinion. They are amazing drugs but you don't fuck around with them.

It’s actually a recommended thing OP. You will get side effects initially (as anyone else would) but your body ‘remembers’ if you like the next month and they are usually gone by month three of intermittently taking them for PMDD. The upside is less side effects than taking them the whole time. Obviously some people need them all month, but if you don’t then that’s great. As with all things like this, it’s trial and error for each person.

Here is the link to MIND on the subject www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/treatment/

“ SSRIs (selective serotonin reuptake inhibitor) are a type of antidepressant. They are often the first recommended treatment for PMDD and are the only type of antidepressant which has been shown to work for PMDD.

Some studies have suggested that SSRIs may work differently for PMDD symptoms than they do for mental health problems such as depression. Your doctor may recommend you take SSRIs daily throughout the whole month or just during your luteal phase. It is normally recommended that you do not start and stop taking SSRIs suddenly, but studies have shown that for some people with PMDD taking SSRIs during just the luteal phase can be effective and withdrawal symptoms are not as intense.”

Pharmacist here. I was also going to say I'd never heard of this and agree with PP but I thought I'd have a look before I dismissed it! Whilst it's not standard practice, it does seem to be something that has been tried, some published studies here;

pubmed.ncbi.nlm.nih.gov/14754784/

jamanetwork.com/journals/jamapsychiatry/fullarticle/2436278

Let me know how you get on!

My GP suggested I do similar. But I take it all month and then take more during the PMS stage. I track my cycles so know when it's going to get bad and start the day before. It seems quite effective this way but as I'm taking it all the time anyway that's a bit different to your suggestion.

This has worked well for a friend of mine who had terrible PMDD. As pp said, the treatment is different to the standard way ADs are used but that's because PMDD is a different condition to depression/anxiety.

@nomorespaghetti
Ask for propanol it's a beta blocker but it works wonders for irritability, rage and feeling overwhelmed.
I had really bad postnatal depression which has left me having rage and irritability all the time and the doctors proscribed me the propanol and they are a life saver.
Defo don't take the sertraline and stop taking ot you will become an emotional mess and it takes 2 weeks for ot to start properly working anyway xx

I’m on Prozac for mine 7 days before. Sometimes less depending when period arrives. Although you not supposed stop start they can be used for severe PMS with no side effects at all.

[quote Sunshinelollypops8]@nomorespaghetti
Ask for propanol it's a beta blocker but it works wonders for irritability, rage and feeling overwhelmed.
I had really bad postnatal depression which has left me having rage and irritability all the time and the doctors proscribed me the propanol and they are a life saver.
Defo don't take the sertraline and stop taking ot you will become an emotional mess and it takes 2 weeks for ot to start properly working anyway xx[/quote]
Yes Propanol can be good if your symptoms are mostly physiological e.g racing heart but SSRIs for part of the month do help some people, so it’s really worth giving it a try. What works for one person may not work for another.

That sounds utterly ridiculous.

This is actually correct advice. So maybe those slagging off the GP should actually do some research on the matter first. If you look up “ssri allopregnanalone” then follow the top link to ncbi article it explains why it works like this. It’s not like using the medication for other depression/anxiety disorders.

However, OP, it may also be worth discussing using your pill continuously rather than cyclically.

@Alltheblue

That sounds utterly ridiculous.

It isn't.

@AltitudeCheck

Pharmacist here. I was also going to say I'd never heard of this and agree with PP but I thought I'd have a look before I dismissed it! Whilst it's not standard practice, it does seem to be something that has been tried, some published studies here;

pubmed.ncbi.nlm.nih.gov/14754784/

jamanetwork.com/journals/jamapsychiatry/fullarticle/2436278

Let me know how you get on!

It’s in NICE guidelines!

@Alltheblue

That sounds utterly ridiculous.

Well I assume you're not a GP then (& also haven't read the links posted)

Here's another: www.cochrane.org/CD001396/MENSTR_selective-serotonin-reuptake-inhibitors-ssris-for-premenstrual-syndrome

The cyclical regimen of taking SSRIs for PMS / PMDD has been shown to be effective - however taking SSRIs continuously may be equally effective.

Different people have different experiences.

The cyclical regime was recommended to me by one GP. My usual GP wasn't as keen, feeling that coming on & off SSRIs could be problematic.

So there are differing opinions. In the end I ended up taking a sub clinical level of SSRI to manage anxiety & it also helped with the worst of PMS - but then as I turned 40, they got worse again, and 5 years later, these & other symptoms have become peri menopause symptoms & I'm on HT.

I have PMDD and this (only taking it when pre menstrual) was prescribed to me as a treatment so it is a 'thing' and is backed up by research. Didnt really work for me but works really well for some women.

Thank you very much everyone for the replies, and the reassuring posts. I think it’s worth a go.

TheCatInTheChat I did try to use the pill continuously but I got breakthrough bleeding and horrendously low mood, so I was just desperate to take the break and have a bleed to reset myself!

My usual GP wasn't as keen, feeling that coming on & off SSRIs could be problematic.

No shit Sherlock.

Don't know why you'd assume I wasn't a medic with that anecdote in your back pocket.

And speaking as someone who has witnessed the extreme instability that can be triggered in some patients when starting and stopping medications, I find this research another example of experimental women's health 'medicine' that has very little respect for women's mental health. Regardless of how much or little it helped you, I don't think this bright idea should have seen the light of day.

There was a Cochrane review which looked at 21 RCTs.
This provided level 1 evidence that SSRIs are the 1st pharmacological approach that should be used.
Based on the evidence there is no difference between continuous treatment or premenstrual only.
For those doubting the GP’s advice, do you think we just make things like this up ??!

I was offered this too, but didn’t take it as I know from DH that you need to use them continuously.
How old are you ? I’m Wondering if HRT might be better if you’re old enough.