Top of the pageDecision Point

You may want to have a say in this decision, or you may simply want to follow your doctor’s recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

PMS: Should I Try an SSRI Medicine for My Symptoms?

Get the facts

Your options

  • Try an SSRI medicine to reduce PMS symptoms.
  • Try lifestyle changes to reduce symptoms.

Key points to remember

  • You may get relief from your PMS symptoms by eating healthy
    foods and by getting enough calcium, vitamin B6, and magnesium. Regular
    exercise can also help, as can cutting back on caffeine. If you smoke, quit.
    After two or three menstrual cycles, you’re likely to feel better.
  • For premenstrual and menstrual pain, try ibuprofen, aspirin, or
    another
    anti-inflammatory medicine. These medicines block
    the pain-producing
    chemicals that increase in the days before your
    period.
  • A selective serotonin reuptake inhibitor (SSRI) can help with
    severe PMS symptoms such as depression, anxiety, anger, mood swings, and muscle
    pain. Most women get relief from PMS symptoms within a few days after they
    start using the medicine, but it may take longer.
  • You can choose
    to take an SSRI every day or only on the days before your period. If your symptoms completely go away during your period,
    taking an SSRI only on premenstrual days is likely to work for you. But if you
    have symptoms such as depression or anxiety all the time, taking an SSRI every
    day may be a better choice.
  • If you are trying to get pregnant,
    talk with your doctor. Taking medicines for PMS in the early weeks of pregnancy
    could increase the chance of having a baby with birth defects.
  • Your doctor may recommend another treatment
    instead of SSRIs if you have had a
    manic episode, if you have
    bipolar disorder or a seizure problem, or if you take
    another medicine that can’t be used along with an SSRI.
FAQs

What is premenstrual syndrome?

Most women have
tender breasts, bloating, and muscle aches a few days before they start their
menstrual periods. These are normal premenstrual
symptoms. But when they get in the way of your work or daily life, they are
called
premenstrual syndrome, or PMS. PMS can affect your
body as well as your mood. Sometimes it can make you change the way you act.

PMS symptoms can be mild or strong. If your symptoms are very
bad, you may have
premenstrual dysphoric disorder (PMDD). But PMDD is
not as common.

What are selective serotonin reuptake inhibitors (SSRIs)?

SSRIs are a type of medicine that can restore the balance of certain brain chemicals called neurotransmitters. This may help relieve physical and emotional symptoms of PMS. SSRIs are also used to treat
depression,
anxiety, menopause
hot flashes, and
chronic pain.

SSRIs are often the
first-choice medicine for treating severe PMS and PMDD symptoms, such
as:

  • Depression.
  • Anxiety.
  • Irritability.
  • Anger.
  • Mood
    swings.
  • Breast tenderness and bloating.
  • Headaches,
    joint pain, and muscle pain.

You can choose to take an SSRI every day or only on
premenstrual days. If you have PMS symptoms that
completely go away during your period, taking an SSRI only on premenstrual days
is likely to work for you. But if you have symptoms such as depression or
anxiety all the time, taking an SSRI every day may be a better choice.

There are several kinds of
SSRIs for PMS. Each can affect your mood in a
different way. One medicine may not be right for you, but another may work
well. Most women feel better within a few days after they start taking the
medicine, but it can take longer.

Your
doctor may recommend treatment other than SSRIs if you have had a
manic episode, if you have
bipolar disorder or a seizure problem, or if you take
another medicine that can’t be used along with an SSRI.

What are the side effects of SSRIs?

Side effects
of SSRIs are common but not serious. But some people stop taking the medicine
because of side effects. Some of these side effects
will go away after you take the medicine for several weeks. Side effects
include:

  • Nausea, appetite changes, and weight loss.
  • Headache.
  • Tiredness and trouble sleeping.
  • Nervousness.
  • Lack of sexual desire, arousal, or
    orgasm.
  • Dizziness.
  • Tremors.
  • Dry mouth.
  • Rash (rare).
  • Weight gain (rare), with long-term
    use.

If you are trying to get pregnant, talk with your doctor.
Taking medicines for PMS in the early weeks of pregnancy could increase your
chance of having a baby with birth defects.

FDA advisories. The U.S. Food and Drug
Administration (FDA) has issued:

  • An advisory on antidepressant medicines and the risk of suicide. Talk to your doctor about these possible side effects and the warning signs of suicide.
  • A warning about taking triptans, used for headaches, with SSRIs
    (selective serotonin reuptake inhibitors) or SNRIs (selective
    serotonin/norepinephrine reuptake inhibitors). Taking these medicines together
    can cause a very rare but serious condition called serotonin syndrome.

Why might your doctor recommend trying an SSRI?

Your doctor may advise you to try an SSRI if:

  • Your PMS symptoms are getting in the way of
    your work or daily life.
  • You have another health problem, such as
    depression, anxiety, or chronic pain, that could be helped with SSRI
    treatment.

Compare your options

Compare

What is usually involved?

What are the benefits?

What are the risks and side effects?

Try an SSRI for
premenstrual symptoms

Try an SSRI for
premenstrual symptoms

  • You take medicine every day or only
    on the days before your period.
  • Most women feel better within a few
    days after they start taking medicine.
  • Side effects include
    nausea, appetite changes, weight loss, headache, trouble sleeping, nervousness,
    and lack of sexual desire.
  • Some medicines for PMS can cause birth
    defects if you take them while you are pregnant.
Try other treatment for
PMS symptoms

Try other treatment for
PMS symptoms

  • You make some lifestyle
    changes, such as cutting back on caffeine and alcohol, eating healthy foods,
    and getting more exercise.
  • You take aspirin or ibuprofen for pain.
  • You avoid the cost of SSRIs.
  • It is safe for you to get pregnant.
  • You avoid the
    side effects of SSRIs.
  • You may still
    have symptoms of PMS that get in the way of your work or daily life.

Personal stories about deciding to take an SSRI for PMS or PMDD

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

When my PMS
symptoms started to interfere with my job performance, I knew I had to treat
them. The first SSRI I tried just didn’t seem to help. But then my doctor
prescribed a different one, and it started to work after about a week. What a
relief!

Sarah, age
34

I’ve had PMS since I was a teenager, so
I’ve had many years to figure out what works for me. A few of my friends use an
SSRI for their PMS problems, and it seems to work for them. For me, I’ve found
that eating right and daily exercise keep me from getting keyed up and angry. I
make sure I keep up with that, especially before my period, because if I don’t,
I’m a different person.

Jonetta, age 29

I didn’t have PMS until my late 30s and
was really thrown for a loop when I started feeling like I had no energy and
having mood swings before my periods. It got to the point where my husband and
kids didn’t want to be around me for a week out of every month. Since I started
taking an SSRI for the latter half of my menstrual cycle, I’m back to my usual
self every month.

Jane,
age 38

I thought I’d be able to try an SSRI for my
PMS problems, but after talking to my doctor, I learned that it could make my
epilepsy worse. So I’ve put more of my energy into improving my diet and
getting plenty of exercise. It really does help.

Diane, age 43

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to try an SSRI

Reasons to try other treatment

My PMS symptoms are affecting my daily life.

My symptoms aren’t that bad.

More important
Equally important
More important

I’ve made changes to my diet and lifestyle, and they are not working.

I’d like to try making diet and lifestyle changes first.

More important
Equally important
More important

I’d like to try an SSRI even though I know there are side effects.

I don’t want to have to deal with side effects.

More important
Equally important
More important

I’m not trying to get pregnant.

I want to get pregnant.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you’ve thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking an SSRI

Trying other treatment

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1, Are SSRI medicines safe to take if you are trying to get pregnant?
2, Do you need to take SSRI medicine every day to ease PMS symptoms?
3, Can you relieve symptoms of PMS on your own?

Decide what’s next

1,Do you understand the options available to you?
2,Are you clear about which benefits and side effects matter most to you?
3,Do you have enough support and advice from others to make a choice?

Certainty

1.
How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure


Your Summary

Here’s a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision 

Next steps

Which way you’re leaning

How sure you are

Your comments

Your knowledge of the facts 

Key concepts that you understood

Key concepts that may need review

Getting ready to act 

Patient choices

Credits

Credits
Author Healthwise Staff
Primary Medical Reviewer Sarah Marshall, MD – Family Medicine
Specialist Medical Reviewer Kirtly Jones, MD – Obstetrics and Gynecology
You may want to have a say in this decision, or you may simply want to follow your doctor’s recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

PMS: Should I Try an SSRI Medicine for My Symptoms?

Here’s a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Try an SSRI medicine to reduce PMS symptoms.
  • Try lifestyle changes to reduce symptoms.

Key points to remember

  • You may get relief from your PMS symptoms by eating healthy
    foods and by getting enough calcium, vitamin B6, and magnesium. Regular
    exercise can also help, as can cutting back on caffeine. If you smoke, quit.
    After two or three menstrual cycles, you’re likely to feel better.
  • For premenstrual and menstrual pain, try ibuprofen, aspirin, or
    another
    anti-inflammatory medicine. These medicines block
    the pain-producing
    chemicals that increase in the days before your
    period.
  • A selective serotonin reuptake inhibitor (SSRI) can help with
    severe PMS symptoms such as depression, anxiety, anger, mood swings, and muscle
    pain. Most women get relief from PMS symptoms within a few days after they
    start using the medicine, but it may take longer.
  • You can choose
    to take an SSRI every day or only on the days before your period. If your symptoms completely go away during your period,
    taking an SSRI only on premenstrual days is likely to work for you. But if you
    have symptoms such as depression or anxiety all the time, taking an SSRI every
    day may be a better choice.
  • If you are trying to get pregnant,
    talk with your doctor. Taking medicines for PMS in the early weeks of pregnancy
    could increase the chance of having a baby with birth defects.
  • Your doctor may recommend another treatment
    instead of SSRIs if you have had a
    manic episode, if you have
    bipolar disorder or a seizure problem, or if you take
    another medicine that can’t be used along with an SSRI.
FAQs

What is premenstrual syndrome?

Most women have
tender breasts, bloating, and muscle aches a few days before they start their
menstrual periods. These are normal premenstrual
symptoms. But when they get in the way of your work or daily life, they are
called
premenstrual syndrome, or PMS. PMS can affect your
body as well as your mood. Sometimes it can make you change the way you act.

PMS symptoms can be mild or strong. If your symptoms are very
bad, you may have
premenstrual dysphoric disorder (PMDD). But PMDD is
not as common.

What are selective serotonin reuptake inhibitors (SSRIs)?

SSRIs are a type of medicine that can restore the balance of certain brain chemicals called neurotransmitters. This may help relieve physical and emotional symptoms of PMS. SSRIs are also used to treat
depression,
anxiety, menopause
hot flashes, and
chronic pain.

SSRIs are often the
first-choice medicine for treating severe PMS and PMDD symptoms, such
as:

  • Depression.
  • Anxiety.
  • Irritability.
  • Anger.
  • Mood
    swings.
  • Breast tenderness and bloating.
  • Headaches,
    joint pain, and muscle pain.

You can choose to take an SSRI every day or only on
premenstrual days. If you have PMS symptoms that
completely go away during your period, taking an SSRI only on premenstrual days
is likely to work for you. But if you have symptoms such as depression or
anxiety all the time, taking an SSRI every day may be a better choice.

There are several kinds of
SSRIs for PMS. Each can affect your mood in a
different way. One medicine may not be right for you, but another may work
well. Most women feel better within a few days after they start taking the
medicine, but it can take longer.

Your
doctor may recommend treatment other than SSRIs if you have had a
manic episode, if you have
bipolar disorder or a seizure problem, or if you take
another medicine that can’t be used along with an SSRI.

What are the side effects of SSRIs?

Side effects
of SSRIs are common but not serious. But some people stop taking the medicine
because of side effects. Some of these side effects
will go away after you take the medicine for several weeks. Side effects
include:

  • Nausea, appetite changes, and weight loss.
  • Headache.
  • Tiredness and trouble sleeping.
  • Nervousness.
  • Lack of sexual desire, arousal, or
    orgasm.
  • Dizziness.
  • Tremors.
  • Dry mouth.
  • Rash (rare).
  • Weight gain (rare), with long-term
    use.

If you are trying to get pregnant, talk with your doctor.
Taking medicines for PMS in the early weeks of pregnancy could increase your
chance of having a baby with birth defects.

FDA advisories. The U.S. Food and Drug
Administration (FDA) has issued:

  • An advisory on antidepressant medicines and the risk of suicide. Talk to your doctor about these possible side effects and the warning signs of suicide.
  • A warning about taking triptans, used for headaches, with SSRIs
    (selective serotonin reuptake inhibitors) or SNRIs (selective
    serotonin/norepinephrine reuptake inhibitors). Taking these medicines together
    can cause a very rare but serious condition called serotonin syndrome.

Why might your doctor recommend trying an SSRI?

Your doctor may advise you to try an SSRI if:

  • Your PMS symptoms are getting in the way of
    your work or daily life.
  • You have another health problem, such as
    depression, anxiety, or chronic pain, that could be helped with SSRI
    treatment.

2. Compare your options

  Try an SSRI for
premenstrual symptoms
Try other treatment for
PMS symptoms
What is usually involved?
  • You take medicine every day or only
    on the days before your period.
  • You make some lifestyle
    changes, such as cutting back on caffeine and alcohol, eating healthy foods,
    and getting more exercise.
  • You take aspirin or ibuprofen for pain.
What are the benefits?
  • Most women feel better within a few
    days after they start taking medicine.
  • You avoid the cost of SSRIs.
  • It is safe for you to get pregnant.
  • You avoid the
    side effects of SSRIs.
What are the risks and side effects?
  • Side effects include
    nausea, appetite changes, weight loss, headache, trouble sleeping, nervousness,
    and lack of sexual desire.
  • Some medicines for PMS can cause birth
    defects if you take them while you are pregnant.
  • You may still
    have symptoms of PMS that get in the way of your work or daily life.

Personal stories

Personal stories about deciding to take an SSRI for PMS or PMDD

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

“When my PMS symptoms started to interfere with my job performance, I knew I had to treat them. The first SSRI I tried just didn’t seem to help. But then my doctor prescribed a different one, and it started to work after about a week. What a relief!”

— Sarah, age
34

“I’ve had PMS since I was a teenager, so I’ve had many years to figure out what works for me. A few of my friends use an SSRI for their PMS problems, and it seems to work for them. For me, I’ve found that eating right and daily exercise keep me from getting keyed up and angry. I make sure I keep up with that, especially before my period, because if I don’t, I’m a different person.”

— Jonetta, age 29

“I didn’t have PMS until my late 30s and was really thrown for a loop when I started feeling like I had no energy and having mood swings before my periods. It got to the point where my husband and kids didn’t want to be around me for a week out of every month. Since I started taking an SSRI for the latter half of my menstrual cycle, I’m back to my usual self every month.”

— Jane,
age 38

“I thought I’d be able to try an SSRI for my PMS problems, but after talking to my doctor, I learned that it could make my epilepsy worse. So I’ve put more of my energy into improving my diet and getting plenty of exercise. It really does help.”

— Diane, age 43

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to try an SSRI

Reasons to try other treatment

My PMS symptoms are affecting my daily life.

My symptoms aren’t that bad.

             
More important
Equally important
More important

I’ve made changes to my diet and lifestyle, and they are not working.

I’d like to try making diet and lifestyle changes first.

             
More important
Equally important
More important

I’d like to try an SSRI even though I know there are side effects.

I don’t want to have to deal with side effects.

             
More important
Equally important
More important

I’m not trying to get pregnant.

I want to get pregnant.

             
More important
Equally important
More important

My other important reasons:

My other important reasons:

   
             
More important
Equally important
More important

4. Where are you leaning now?

Now that you’ve thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking an SSRI

Trying other treatment

             
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1.
Are SSRI medicines safe to take if you are trying to get pregnant?

  • Yes

  • No
  • I’m not sure

You’re right. If you are trying to get pregnant, talk with your doctor. Taking medicines for PMS in the early weeks of pregnancy could increase your chances of having a baby with birth defects.

2.
Do you need to take SSRI medicine every day to ease PMS symptoms?

  • Yes

  • No
  • I’m not sure

You’re right. You can choose to take an SSRI every day or only on premenstrual days.

3.
Can you relieve symptoms of PMS on your own?

  • Yes
  • No

  • I’m not sure

You’re right. You may find relief from your symptoms by eating healthy foods and getting enough calcium, vitamin B6, and magnesium. Exercise can also help. Cut back on caffeine. Try aspirin or ibuprofen for pain.

Decide what’s next

1.
Do you understand the options available to you?

2.
Are you clear about which benefits and side effects matter most to you?

3.
Do you have enough support and advice from others to make a choice?

Certainty

1.
How sure do you feel right now about your decision?

         
Not sure at all
Somewhat sure
Very sure

2.
Check what you need to do before you make this decision.

  • I’m ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

 

Credits
By Healthwise Staff
Primary Medical Reviewer Sarah Marshall, MD – Family Medicine
Specialist Medical Reviewer Kirtly Jones, MD – Obstetrics and Gynecology

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