Sertraline (Zoloft) For PMDD: Evidence, Side Effects & More

PMDD can be very painful. Image by Freepik.

Sertraline (Zoloft) for PMDD

This article contains a summary of information available for taking Sertraline (Zoloft) for PMDD. 

Sertraline is classified as an SSRI, short for selective serotonin reuptake inhibitor. As the name implies, this class of medications works by blocking the reuptake of serotonin in the brain's nerve cell synapses, which consequently increases serotonin's effect on the brain.

PMDD stands for premenstrual dysphoric disorder and represents a severe form of premenstrual syndrome (PMS). It is estimated that 2 to 9% of menstruating women suffer from premenstrual dysphoric disorder. The symptoms of PMDD include feeling anxious, sad, angry, experiencing mood swings, as well as being lethargic and tired. Complaints of a bloated stomach, headaches, joint-pain, and breast tenderness are also common. The disorder is characterized by the symptoms occurring in a cyclic pattern during the second half of the menstrual cycle.

The provided information is not individual medical advice. Remember to always consult with your physician before starting Sertraline for PMDD, or if you are experiencing potential side effects from the medication.

Evidence

• The U.S. Food & Drug Administration (FDA) has approved treatment with Sertraline for PMDD.

• Sertraline, as well as Fluoxetine, are both considered first-line treatment of PMDD and are proven to be very well-tolerated. 

• Taking Sertraline (Zoloft) for PMDD has been shown to reduce all symptoms of PMDD, including depression, anger, irritability, appetite and food cravings, concentration and memory effects, and physical symptoms.

Treatment with Sertraline (Zoloft) for PMDD

• The dosage of Sertraline, when treating PMDD, is commonly 50-150 mg daily. The dosage is the same whether the treatment is continuous or intermittent.

• Studies indicate that intermittent administration with Sertraline for PMDD, known as luteal phase dosing, may be beneficial with fewer side effects than continuously taking the drug. 

• Luteal phase dosing is also known as premenstrual dosing, in which case Sertraline is taken only between the onset of premenstrual symptoms (commonly 14 days before anticipated bleeding) and stopped with the onset of menses.

• Luteal phase dosing does not increase the risk of withdrawal or discontinuation symptoms from Sertraline. 

Potential Side Effects

• Common side effects that might occur when taking Sertraline include dizziness, nausea, loss of appetite, dry mouth, diarrhea, insomnia, and increased sweating. It may also cause sexual dysfunction. In women, this commonly presents as decreased sexual drive and difficulties in achieving orgasm.

• Severe symptoms include significant weight loss, a higher risk of bleeding, seizures, and serious allergic reactions.

• Sertraline has been issued an FDA black box warning because of the increased risk of suicidal thoughts and behaviors in children, teenagers, and young adults during the first weeks of treatment.

Absolute Contraindications

• Allergy to Sertraline or any other selective serotonin reuptake inhibitor.

• Moderate to severe liver problems.

• Usage of MAOI drugs during the previous 14 days.

Useful Information

• The most common side effects of Sertraline can often be avoided by starting with a low dose and gradually increasing it if necessary.

• Side effects from Sertraline usually disappear by themselves within the first couple of weeks of starting treatment.

• It is recommended to avoid eating grapefruit while taking Sertraline for PMDD, as it contains an enzyme that might affect the potency of the drug, thus making it less effective. 

Author: J. Martin, M.D. 
Last updated: September 11, 2023

Disclaimer: The information provided is intended for general informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider, such as a physician, before starting any new treatment or making changes to your existing treatment plan. Individual responses to treatment may vary, and a healthcare professional can provide personalized guidance based on your specific needs and circumstances. If you are experiencing severe or persistent symptoms of the disease seek immediate medical attention.