A report in the May issue of the Archives of General Psychiatry (one of the JAMA/Archives journals) indicates that many women take the antidepressant called sertraline to relieve severe premenstrual symptoms, and it seems that half of them go through relapse after six to eight months after stopping the medication. There is a higher probability of relapse for women with more severe symptoms and those who consumed the drug during a shorter period.
Background facts sustained in the report demonstrate that premenstrual syndrome (PMS) is one of the most frequent health problems among women of reproductive age. Sertraline hydrochloride and other antidepressant medications are approved to treat PMS when it is most severe, also known as premenstrual dysphoric disorder (PMDD).
The authors explain: “There is little information about the optimal duration of treatment, although anecdotal reports and small pilot investigations suggest that premenstrual symptoms return rapidly in the absence of effective medication.”
A study lasting eighteen months involving one hundred and seventy four women with PMS or PMDD was conducted by Ellen W. Freeman, Ph.D. and colleagues at the University of Pennsylvania School of Medicine, Philadelphia. The women were randomly divided in two groups. Eighty seven of them received short-term treatment by taking sertraline for four months and then switching to placebo for fourteen months. The second group of eighty seven participants received long-term treatment of sertraline for twelve months and placebo for six months. Neither the women nor the researchers had knowledge of the treatment assignments.
Following treatment, results showed that 72 percent (125 out of 174 patients) presented improvement during the first four months. Relapse is identified as the return to the stage of symptoms as they were before treatment started. After long-term treatment, 41 percent of women experienced relapse with an average midpoint time of eight months. After short-term treatment, 60 percent of women showed deterioration with an average midpoint time of four months.
The researcher explain: “Patients with severe symptoms at baseline were more likely to experience relapse compared with patients in the lower symptom severity group and were more likely to experience relapse with short-term treatment. Duration of treatment did not affect relapse in patients in the lower symptom severity group.” Results showed 24 percent (41) of the patients presented weakening of premenstrual symptoms and were less likely to experience relapse after four months.
“How long medication should be continued after achieving a satisfactory response and the risk of relapse after discontinuing treatment are important concerns for women and clinicians, given the possible adverse effects and cost of drugs vs. the benefit of medication that improves symptoms, functioning and quality of life,” the authors explain. “These findings suggest that the severity of symptoms at baseline and symptom remission with treatment should be considered in determining the duration of treatment.”
“Time to Relapse After Short- or Long-term Treatment of Severe Premenstrual Syndrome With Sertraline”
Ellen W. Freeman; Karl Rickels; Mary D. Sammel; Hui Lin; Steven J. Sondheimer
Arch Gen Psychiatry. 2009; 66:537-544.
Written by Stephanie Brunner (B.A.)