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What is the best medicine for premenstrual dysphoric disorder?

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Practicing since : 2001
Answered : 12880 Questions
I am a 41-year-old female recently disgnosed with PMDD with my symptoms being anxiety, weepiness, irritability, headaches and insomnia only around my period. I'm seeking a second opinion on my treatment plan from my GYN (whom I trust very much but I always like a second opnion):
1. She recently switched my birth control pills from a triphasic to a monophasic (OrthoCyclen). I'm starting the third pack today and my GYN said to give it three packs for my body to adjust before considering increasing Sertraline from 50mg to 100mg. Is there a better birth control pill for PMDD? I'm concerned about Yaz's increased blood clot rate. Should I consider taking three packs of OrthoCyclen in a row to reduce the number of periods I have? Would Seasonale be better?
2. Sertraline daily 50mg (may increase to 100mg if I don't have relief after the third pack of OrthoCylcen)
3. Diet and exercise
4. 1200mg calcium carbonate
5. 100mg B-6
Do you have any comments about the above plan or about additional strategies? THANK YOU!! Ma
Sat, 9 Jun 2018 in Pregnancy
Answered by Dr. Rakhi Tayal 58 minutes later
Brief Answer:
Orthocyclen is a good option.

Detailed Answer:
Thanks for posting your query.

1. Monophasic pills are lesser likely to be associated with symptoms of PMDD or depression. These are associated with lesser variation in the hormonal levels. After starting the pills it takes 2-3 cycles for the hormones to settle down and the cycles to become regular. Orthocyclen is a good option and now that you have started the pack it is best to continue with it and not to consider other contraceptives. Seasonale is extended cycle pills and Orthocyclen is better to maintain a normal hormonal balance.

2. SSRIs that have shown to be effective in the treatment of PMDD include Fluoxetine (Prozac, Sarafem), Sertraline (Zoloft), Paroxetine (Paxil), etc. It is best to start with a low dose - 50 mg and increase the dose in case the symptoms do persist after 3-4 months also.

3. Rest of the supplements, exercise and relaxation exercises like deep breathing are also an integral part of the treatment.

You are presently getting the correct treatment. Do go for regular follow up and stick to this plan.

In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.

Wishing you good health.

I hope this answers your query.

Dr. Rakhi Tayal.
For future query, you can directly approach me through my profile URL
Above answer was peer-reviewed by
Follow-up: What is the best medicine for premenstrual dysphoric disorder? 2 hours later
Thank you. Should I also take magnesium anf if so, how much? And should the calcium supplement also contain vitamin D for calcium absorption?
Answered by Dr. Rakhi Tayal 5 hours later
Brief Answer:
You can have calcium with vitamin D3.

Detailed Answer:
Thanks for writing again.
Magnesium supplements are not needed if you a re not having symptoms like muscle cramps or dizziness. You can eat magnesium rich foods like bananas, beans, chickpeas, fish, nuts, soybeans, spinach etc which are natural sources of magnesium.
Having calcium supplement along with vitamin D3 is always better.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
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