A Preliminary Study of Luteal Phase Versus Symptom-Onset Dosing With Escitalopram for Premenstrual Dysphoric Disorder
J Clin Psychiatry 2005;66(6):769-773
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: This preliminary study compared
the efficacy and tolerability of escitalopram administered
at symptom onset or throughout the
luteal phase in premenstrual dysphoric disorder
Method: Twenty-seven women meeting
DSM-IV criteria for PMDD were randomly assigned
in a double-blind manner to luteal phase
(N = 13) or symptom-onset (N = 14) dosing of
escitalopram (10–20 mg/day) for 3 consecutive
menstrual cycles. Participants were enrolled from
November 2002 to July 2003, and data collection
was completed in December 2003. Symptoms
were assessed using the 17-item Penn Daily
Symptom Report (DSR), the Clinical Global
Impressions-Improvement scale, the Hamilton
Rating Scale for Depression, and the Sheehan
Disability Scale. Scores were compared using
repeated measures analysis of covariance and
Results: Luteal phase and symptom-onset
groups received escitalopram for a mean of 13.5
and 6.0 days, respectively (mean ± SD dose =
15.2 ± 5.1 mg/day at the third treatment cycle).
Total premenstrual DSR scores significantly
improved from baseline (p = .003), with a 57%
decrease in the luteal phase group and a 51%
decrease in the symptom-onset group. Clinical
improvement (DSR score decrease ≥ 50% from
baseline) was reported by 11 of 13 patients in
the luteal phase group and 9 of 14 patients in
the symptom-onset group. Symptom severity
differentiated the response in the symptom-onset
group, with those having more severe symptoms
less likely to respond. Symptom severity did
not differentiate treatment response to luteal
phase dosing. Escitalopram was well tolerated.
Adverse events were mild and transient, with
only 2 patients discontinuing due to adverse
events related to the medication.
Conclusion: Premenstrual dysphoric disorder
improved significantly with either luteal phase or
symptom-onset dosing of escitalopram. Women
with more severe PMDD may respond better to
luteal phase dosing than symptom-onset dosing.