Antidepressants and oral contraceptives - dont work for PMDD

A recent study² which reviewed data from studies dating from 1990 to 2008 to research those randomized, double-blind, placebo-controlled clinical trials of selective serotonin re-uptake inhibitors (SSRIs), a type of anti-depressant and combined oral contraceptives (COCs) to determine how much of an effect they had on women with symptoms of PMS and  symptoms of PMDD.

After reviewing the data, measurements and outcome of all of the large-scale studies, the authors of the review² noted that once the placebo effect was discounted, the actual results showed that the percentage of women who had a beneficial outcome from using SSRIs or COCs was not much more than the women who did not have any benefit from using these medications. In other words, women who used SSRIs or contracetives had the same level of PMS/PMDD symptoms as women who did not use the medications.

The authors of the review² also noted that around 40% of women with PMS/PMDD symptoms did not have a positive outcome from using the SSRIs medications - their symptoms did not improve. They also stated that treatment with COCs also does not substantially improve the symptoms in women with PMS/PMDD.

The authors of the review² suggested that "additional alternative targeted treatment modalities need to be developed" for more adequate treatment of PMS/PMDD than is currently available.

Other studies recently suggest that anti-depressants don't help people with mild to moderate depression and as depression can be one of the symptoms of severe PMS/PMDD, that suggests again, quite clearly, that anti-depressants are not going to help women with severe PMS/PMDD symptoms either.

A recent review^1,3 of a number of randomised studies of people using anti-depressants for depression found that there was little evidence that anti-depressants have an effect that is any different to a placebo for people with mild to moderate depression.  In other words, using anti-depressants and using placebos (no drug) have the same effect.

References:

1. Fournier JC, DeRubeis RJ et al. Antidepressant Drug Effects and Depression Severity: A Patient-Level Meta-analysis. JAMA. 2010;303(1):47-53. Accessed 8 July 2010
2. Halbreich U. Selective serotonin reuptake inhibitors and initial oral contraceptives for the treatment of PMDD: effective but not enough. CNS Spectr. 2008 Jul;13(7):566-72. Accessed 8 July 2010 
3. Silverman E. Antidepressants Don’t Help Mild Depression: Study. Pharmalot online. 5 January 2010. Accessed 8 July 2010