A Preliminary Study of Luteal Phase Versus Symptom-Onset Dosing With Escitalopram for Premenstrual Dysphoric Disorder

Objective: This preliminary study comparedthe efficacy and tolerability of escitalopram administeredat symptom onset or throughout theluteal phase in premenstrual dysphoric disorder(PMDD).

Method: Twenty-seven women meetingDSM-IV criteria for PMDD were randomly assignedin a double-blind manner to luteal phase(N = 13) or symptom-onset (N = 14) dosing ofescitalopram (10-20 mg/day) for 3 consecutivemenstrual cycles. Participants were enrolled fromNovember 2002 to July 2003, and data collectionwas completed in December 2003. Symptomswere assessed using the 17-item Penn DailySymptom Report (DSR), the Clinical GlobalImpressions-Improvement scale, the HamiltonRating Scale for Depression, and the SheehanDisability Scale. Scores were compared usingrepeated measures analysis of covariance andt statistics.

Results: Luteal phase and symptom-onsetgroups received escitalopram for a mean of 13.5and 6.0 days, respectively (mean ± SD dose =15.2 ± 5.1 mg/day at the third treatment cycle).Total premenstrual DSR scores significantlyimproved from baseline (p = .003), with a 57%decrease in the luteal phase group and a 51%decrease in the symptom-onset group. Clinicalimprovement (DSR score decrease ≥ 50% frombaseline) was reported by 11 of 13 patients inthe luteal phase group and 9 of 14 patients inthe symptom-onset group. Symptom severitydifferentiated the response in the symptom-onsetgroup, with those having more severe symptomsless likely to respond. Symptom severity didnot differentiate treatment response to lutealphase dosing. Escitalopram was well tolerated.Adverse events were mild and transient, withonly 2 patients discontinuing due to adverseevents related to the medication.

Conclusion: Premenstrual dysphoric disorderimproved significantly with either luteal phase orsymptom-onset dosing of escitalopram. Womenwith more severe PMDD may respond better toluteal phase dosing than symptom-onset dosing.’ ‹