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The newest indication for sertraline is the treatment of PMDD.

Sertraline has been shown to improve quality-of-life scores and psychologic and behavior symptoms in patients with PMDD.1516 [Reference 15—Evidence level A, RCT] Its effectiveness has been demonstrated with both continuous dosing throughout the month and luteal-phase dosing.

The choice of antidepressant drug depends on the agent's pharmacologic profile, secondary actions, and tolerability.

Sexual dysfunction related to the use of antidepressants may be addressed by reducing the dosage, switching to another agent, or adding another drug to overcome the sexual side effects.

This may be caused by fluoxetine's relative lack of selectivity over norepinephrine and serotonin-2C receptors (5-HT).3 These side effects are short-lived and may improve with a dose reduction or temporary co-administration of a beta-adrenergic blocker or long-acting benzodiazepine.7 Clinically important drug interactions are listed in Any drug that increases serotonin concentrations, including: MAOIs, tramadol (Ultram), sibutramine (Meridia), meperidine (Demerol), sumatriptan (Imitrex), lithium, St. In two studies, male and female outpatients with PTSD who were randomized to 12 weeks of treatment with sertraline experienced significantly more relief from symptoms of avoidance/numbing and hyperarousal than did patients treated with placebo.1314 [References 13 and 14—Evidence level A, RCTs] Intrusive thoughts/re-experiencing phenomena also improved, although the degree of improvement was not statistically significant for each symptom scale.

John's wort, ginkgo biloba, and atypical antipsychotic agents Adapted with permission from Kando JC, Wells BG, Hayes PE. Whether patients with PTSD will benefit from long-term treatment with sertraline or a combination of the drug and behavior therapy is presently unknown.

Although this is the predominant mechanism of action of this class of drugs, each SSRI has a slightly different pharmacologic profile that leads to its distinct clinical activity, side effects, and drug interactions.3 Six SSRIs are currently marketed in the United States; five of them have been approved by the U. Food and Drug Administration (FDA) for the treatment of depression Costs are average wholesale prices for 30 days of the lowest-dose therapy from Red Book. J.: Medical Economics Data, 2002, rounded to the nearest dollar.

The usual dosage of the drug is 20 mg orally once daily throughout the month10 .

Administration of fluoxetine during the late luteal phase alone has been investigated in a small study11 of 24 women with PMDD and no psychiatric history.

Fluoxetine (under the trade name Sarafem) is now indicated for the treatment of premenstrual dysphoric disorder (PMDD), also known as late luteal dysphoric disorder or premenstrual syndrome.

Improvement in symptoms of tension, irritability, and dysphoria has been demonstrated.9 [Evidence level A, randomized controlled trial (RCT)] Side effects were comparable with those reported in studies of fluoxetine used for other indications.

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