Premenstrual dysphoric disorder (PMDD)

Severe form of premenstrual syndrome with marked affective symptoms. Foundation: SSRIs (cyclic or continuous), drospirenone-containing oral contraceptives, and CBT.

ICD-10 N94.32 drugs

Also known as: PMDD

Drugs used for this condition

ADrospirenone + ethinylestradiolFirst line · Combined oral contraceptives — antimineralocorticoid progestinYaz (drospirenone 3 mg + ethinylestradiol 20 mcg, 24/4 regimen) is FDA-approved for premenstrual dysphoric disorder (PMDD) in patients seeking oral contraception. The 2017 Cochrane meta-analysis confirms significant symptom reduction. In patients not needing contraception, SSRIs (cyclic or continuous) are first-line.

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

DVitex agnus-castus (chasteberry, monk's pepper)Not recommended · Herbal preparation for PMS, supplement. In EU – traditional herbal medicinal product (EMA HMPC). AEMPS does not register as medicineVitex is sold for PMDD (premenstrual dysphoric disorder) as a «natural antidepressant» promising reduction in irritability, depression and anxiety in luteal phase. Evidence in PMDD (severe PMS form, DSM-5) is weak: RCTs with DRSP (Daily Record of Severity of Problems) and PMDD scale endpoints are minimal. ACOG 2014 lists SSRIs (fluoxetine, sertraline) continuously or in luteal phase first-line for PMDD; vitex is not in main international guidelines. If vitex was recommended for PMDD with marked depression, suicidal thoughts or daily-life impairment instead of psychiatric consultation, consider seeking a second opinion.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit