Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment, blinding and selective reporting).
A Cochrane review included 31 studies with a total women in the primary analysis of reduction in overall symptomatology. SSRIs were found to be highly effective in treating the premenstrual symptoms (SMD – 0.65, 95% CI -0.46 to -0.84; I²=58%, 9 trials, n=1276). Secondary analysis showed that they were effective in treating physical , functional and behavioural symptoms . Luteal phase only and continuous administration were both effective. All SSRIs (fluoxetine, paroxetine, sertraline, escitalopram, and citalopram) were effective. Withdrawals due to side effects were twice as likely to occur in the treatment group (OR moderate dose: OR 2.55, 95% CI 1.84 to 3.53; 15 studies, n=2447 women; no heterogeneity).The most common side effects associated with a moderate dose of SSRIs were nausea (NNH = 7), asthenia or decreased energy (NNH = 9), somnolence (NNH = 13), fatigue (NNH = 14), decreased libido (NNH = 14) and sweating (NNH = 14).
A systematic review including 5 RCTs with a total of 1 063 subjects was abstracted in DARE. The overall standardised mean difference was –1.066 (95% CI –1.381 to –0.750) and an OR of 6.91 (95% CI 3.90 to 12.29) in favour of SSRIs. Withdrawal due to side effects was 2.5 times more likely in the active-treatment group than in the placebo group (OR 2.42, 95% CI 1.59 to 3.67). SSRIs were not statistically more effective than other antidepressants (3 trials), SMD 0.287, 95% CI –0.586 to 0.011).
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