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Treating Premenstrual Dysphoric Disorder (PMDD)

The following treatment guidelines are meant as a reference tool only, and are not intended as treatment advice or to replace the clinical decision-making process of psychiatrists or other health professionals who administer these treatments. In clinical practice there are often good reasons why treatment approaches differ from what is described here.


An SSRI, given at a low dose and only during the luteal phase (the 2 week period from ovulation to the onset of menses), is the recommended treatment [ref, ref].  Other antidepressants with strong serotonergic action, like Clomipramine or Venlafaxine, could also be tried [ref, ref]. 

Using any of these medications throughout the entire menstrual cycle (ie. continuously) is also an option [ref, ref]. If a low dose of the medication is not effective, then it can be increased with every menstrual cycle until it is effective or the maximum tolerated dose has been reached.

If these approaches are not effective, an oral contraceptive pill can be tried [ref, ref].

Various other kinds of treatment, including psychotherapy, exercise and relaxation techniques, and different kinds of vitamins and minerals, have also been tried [ref]. For most of these treatments there is still not enough evidence to have a good sense of whether they are effective. However, there have been a couple of studies supporting the use of Cognitive Therapy for PMDD, which have shown benefits that continue even after the therapy is complete [ref]. The Chasteberry plant is a natural product that also seems to be effective at treating the symptoms of PMDD, especially the physical ones [ref].


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Postpartum Depression