Conventional treatment for mild PMS usually focuses on NSAIDs, which reduce smooth muscle contractions and cramping. In addition, some of the drugs that have shown benefit, such as benzodiazepines, have risk for addiction and abuse.
Antidepressants. Antidepressants (eg, SSRIs) are commonly used for depression associated with PMS and PMDD (Freeman 2004; Baldessarini 2001). Serotonin reuptake inhibitors that are commonly used to treat PMS include Prozac® (fluoxetine) and Zoloft® (sertraline) (Berga 2005). These drugs typically require a 2 to 3-week phase-in period before reaching maximum effectiveness. They should be used continuously until both patient and physician agree to stop using them, and then they should be phased out gradually. They cannot be used on an “as needed” basis. Side effects associated with SSRIs include nausea, diarrhea, tremor, weight loss, and headache.
Benzodiazepines. This class of medications is used to induce sedative, muscle-relaxant, and anticonvulsant effects (Baldessarini 2001). Benzodiazepines have effects similar to allopregnanolone, a metabolite of progesterone that acts at the brain receptor sites where benzodiazepines operate. Xanax® (alprazolam) is a commonly prescribed benzodiazepine. However, these drugs have a serious risk of addiction and abuse.
Non-steroidal anti-inflammatory drugs (NSAIDs). Over-the-counter (OTC) NSAIDs such as ibuprofen (Motrin®) and naproxen sodium (Aleve®) are commonly used to ease uterine cramping and breast tenderness (Mayo Clinic 2005). These drugs inhibit prostaglandin synthesis (Neal 2002).
Others. Bromocriptine, an ergot alkaloid that blocks the release of prolactin from the pituitary gland, is often given to treat breast tenderness associated with PMS (Meden-Vrtovec 1992).