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Are there Differential Symptom Profiles that Improve in Response to Different Pharmacological Treatments of Premenstrual Syndrome/Premenstrual Dysphoric Disorder?

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Abstract

Current evidence suggests that the accepted treatments for premenstrual syndrome (PMS)/premenstrual dysphoric disorder (PMDD) have similar overall efficacy. While these treatments are more effective than placebo, response rates associated with them are far from satisfactory (<60%), such that, irrespective of treatment modality, there remain a significant number of women who are unresponsive to current conventional pharmacological therapy.

The available data on response rates of specific types of premenstrual symptoms to, or symptom profiles that are most amenable to, each treatment modality are limited and not well defined because most studies were not designed to assess specific symptom profiles. Those studies that have attempted to evaluate which symptom profiles respond to specific therapies have revealed variations within the individual modalities, as well as between the different modalities. It appears that suppression of ovulation ameliorates a broad range of behavioural as well as physical premenstrual symptoms. SSRIs are most effective for irritability and anxiety symptoms, with lesser efficacy for ‘atypical’ premenstrual symptoms. GABAergic compounds are most efficacious for anxiety and anxious/depressive symptoms, while dopamine agonists, particularly bromocriptine, are perhaps most efficacious for mastalgia.

Overall treatment response rates may improve if treatments are targeted at well-defined subgroups of patients. Re-analysis of available datasets from randomised clinical trials may shed more light on the notion that targeting women with specific premenstrual symptom profiles for specific treatment modalities would improve response rates beyond the current ceiling of approximately 60%. Such information would also improve understanding of the putative pathophysiological mechanisms underlying PMS and PMDD, and may point to a more specific diagnosis of these conditions.

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  1. The use of trade names is for product identification purposes only and does not imply endorsement.

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Acknowledgements

The authors would like to thank Sandhya Karkun, MS, for providing library and research assistance, and Richard Glover, Wolters Kluwer Health Medical Communications for editorial assistance. This project was supported by an unrestricted educational grant from Schering AG. The authors’ work was completely independent of the sponsor.

Uriel Halbreich received grant/research support from Eli Lilly, Wyeth, Bristol Myers Squibb (BMS), Schering, Janssen and Pfizer, has been a consultant for Schering, Janssen, Berlex and Wyeth, and has received honoraria from Schering, Janssen, Pfizer and Wyeth. PMS O’Brien received research/grant support from the British Heart Foundation and Novo Nordisk, and has been a consultant for Schering AG. Elias Eriksson received research/grant support from Lundbeck, BMS and GlaxoWellcome, and is a consultant for and has received honoraria from Lundbeck, Eli Lilly and Schering. Torbjörn Bäckström received research/grant support from Organon, Orion Pharma and Schering, and has served as a consultant for Organon, Orion Pharma and Schering. Kimberly Yonkers received research/grant support from SmithKline Beecham and Wyeth-Ayerst, is a consultant for Berlex and Wyeth and has received honoraria from Berlex. Ellen Freeman received research/grant support from Wyeth, Berlex, Eli Lily, GlaxoSmithKline, Pherin and Forest, and is a consultant for Wyeth, Pherin, Eli Lilly, Berlex and Pfizer. She received an honorarium from Wyeth, Pfizer and Forest and is also on the Speakers’ Bureau for Wyeth, Pfizer and Werner-Chilcott.

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Halbreich, U., O’Brien, P., Eriksson, E. et al. Are there Differential Symptom Profiles that Improve in Response to Different Pharmacological Treatments of Premenstrual Syndrome/Premenstrual Dysphoric Disorder?. CNS Drugs 20, 523–547 (2006). https://doi.org/10.2165/00023210-200620070-00001

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