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A Randomized Controlled Trial

Ellen W. Freeman, PhD; Karl Rickels, MD; Steven J. Sondheimer, MD; Marcia Polansky, ScD

Arch Gen Psychiatry. 1999;56:932-939.

Background  Studies show that selective serotonin reuptake inhibitors are effective for severe premenstrual syndrome and premenstrual dysphoric disorder. This study compares the efficacy of a selective serotonin reuptake inhibitor with that of a tricyclic antidepressant to determine whether efficacy for premenstrual syndrome/premenstrual dysphoric disorder is a general or more serotonergic effect of antidepressants.

Methods  After 3 screening months, 189 subjects were randomized to sertraline hydrochloride, desipramine hydrochloride, or placebo for 3 months of double-blind treatment. The flexible dosage range was 50 to 150 mg/d. The outcome measures included the Penn Daily Symptom Report (DSR), the Hamilton Depression Rating Scale, the Clinical Global Impressions–Severity Scale, the Quality of Life Scale, and Patient Global Ratings of Functioning and Improvement. Analyses included all subjects with treatment data, with the last observation carried forward.

Results  Sertraline was significantly more effective than placebo or desipramine; desipramine was not better than placebo (F_2,163=12.47, P<.001). All DSR factors were more improved with sertraline compared with desipramine and placebo; the factors for mood (P<.001) and pain (P=.05) were significant, and the results of all outcome measures were consistent. A history of depression, postmenstrual symptom levels, and other diagnostic variables added individually as covariates did not alter the treatment results. At end point analysis, DSR symptoms had decreased by more than 50% in 40 subjects (65%) in the sertraline group, 18 subjects (36%) in the desipramine group, and 16 subjects (29%) in the placebo group (P<.001).

Conclusions  The comparison of 2 classes of antidepressants strongly favored the serotonergic drug, which effectively reduced symptoms and improved functioning and was well tolerated by women with severe premenstrual syndrome. A history of depression did not alter the treatment results.

From the Departments of Obstetrics/Gynecology (Drs Freeman, Rickels, and Sondheimer) and Psychiatry (Drs Freeman and Rickels), School of Medicine, University of Pennsylvania, Philadelphia; and School of Public Health, Medical College of Pennsylvania, Hahnemann University, Philadelphia (Dr Polansky).

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