PMDD and SSRIs: Is Part-Time Use Better Than Daily Doses?

Here at Her Mood Mentor, we stay on top of the latest research on treating Premenstrual Dysphoric Disorder (PMDD). The two treatments in Western medicine for PMDD are (1) SSRIs or antidepressants and (2) hormonal birth control. When it comes to integrative medicine protocols, there are many, including nutritional therapy, regular exercise, sleep hygiene, and stress management.

While I teach natural healing methods, some women opt for medication first. It helps them feel stable enough to focus on lifestyle changes. There is no judgment in how we choose to treat or manage our PMDD symptoms. It is important, however, to have a clear understanding of the side effects and risks of any treatment option. Unfortunately, I’ve met hundreds of PMDDers who were handed SSRI prescriptions without informed consent around the side effects and risks of antidepressants (myself included!).

Women and SSRIs

According to the Centers for Disease Control and Prevention, in 2015-2018, 13.2% of adults aged 18 and over used antidepressant medication, also known as selective serotonin reuptake inhibitors (SSRIs), in the past 30 days. Use was significantly higher among women (17.7%) than men (8.4%). This means that over 28 million women in 2018 were on antidepressant medication. Antidepressant use during 2015-2018 also increased with age, with use being the highest among women aged 60 and over (24.3% of that population). The millions of women on SSRIs is even higher in today’s post-pandemic world.

A major risk of SSRIs: withdrawal 

Stopping SSRIs or even reducing your dose often causes withdrawal symptoms. Doctors used to think these symptoms were rare and mild. We now know that’s not true.

Withdrawal symptoms occur in up to half of antidepressant users – with an increasing chance of withdrawal symptoms with longer term use. Drug companies tested SSRIs for only 6-12 months of use. Yet many women take them for most of their adult lives. This makes the likelihood of withdrawal even higher.

Stopping or reducing you antidepressant can cause withdrawal. The symptoms can can range from mild to severe. These symptoms can make daily life much harder.

Some of the most commonly reported antidepressant withdrawal symptoms include: 

• Irritability
• Confusion 

• Fatigue 
• Insomnia 
• Anger 
• Nausea 

To understand why withdrawal symptoms occur, it’s important to understand how antidepressant medications work in our bodies. When you take antidepressants daily, your body adapts to them. Different medications work in different ways, but they all change your brain chemistry. They affect key brain chemicals like serotonin, noradrenaline, and dopamine.

Think of your body like a car that’s adjusted to run on premium gas. When you switch back to regular gas, the engine sputters. The same happens with SSRIs – your body gets used to them. When the medication level drops, your system struggles to adjust. That’s withdrawal.

Antidepressant withdrawal and PMDD symptoms 

Notice anything about the antidepressant withdrawal symptoms listed above? They massively overlap with PMDD symptoms. When you start feeling better and try to stop your SSRIs, new symptoms can arise. But these may not be your PMDD coming back – they could be withdrawal symptoms. This mix-up can be frustrating. This leaves many women feeling defeated after working so hard to get better.

Intermittent use of SSRIs and PMDD

A 2022 study on intermittent use of SSRIs offers a new perspective. In this study, hundreds of women with PMDD took SSRIs during their luteal phase only, as opposed to taking SSRIs every day of their cycle. The hope was that this avoids the risk of the antidepressant withdrawal syndrome associated with long-term continuous use of SSRIs. 

The study found that taking SSRIs only during certain days of your cycle might be safer. Why? Your body doesn’t get fully dependent on the medication. This means less risk of withdrawal symptoms when you stop. (source). 

Making Informed Choices About SSRI Treatment

Choosing to use SSRIs intermittently may be a safer alternative than taking them daily. While you should never stop SSRIs without medical support, be aware that not all doctors are trained in safe tapering methods. Do your research to find a provider experienced in SSRI withdrawal. For reliable tapering guidance, I trust Outro as a resource.

Listen to our PMDD Pep Talk Podcast episode with Charlotte Herring (Outro’s Lead NP).

Ready to rewrite your PMDD story?

Start by getting informed about your treatment options in both Western medicine and integrative medicine. Remember, knowledge is power, and understanding your options is the first step toward reducing and better managing PMDD symptoms.

Looking for community support?

Join our practitioner-led online community.

Want to go deeper into understanding and healing PMDD?

Join us in PMDD Rehab, where we’ll guide you step by step through a comprehensive approach to reducing and managing your symptoms. In our course, we dive deep into practical strategies for addressing stress, optimizing movement, improving sleep quality, adapting your diet, and so much more.

Remember: taking medication to treat PMDD isn’t “wrong” or “right”. It’s about finding what’s best for you and where you’re at in life right now. 

______________________________________________________________________________________

IMPORTANT MEDICAL DISCLAIMER:

The information in this article about SSRIs and PMDD is for educational purposes only. It does not constitute medical advice.

MEDICATION WARNING: Never stop, start, or alter your SSRI medication without direct supervision from your prescribing physician. Changing or discontinuing SSRIs can lead to serious side effects, including increased risk of suicidal thoughts. This is especially critical during the luteal phase of PMDD.

If you’re experiencing thoughts of suicide or self-harm, please seek immediate medical attention or contact your local emergency services. You can also reach the 988 Suicide & Crisis Lifeline 24/7 by calling or texting 988.

Always consult with qualified healthcare providers about your specific medical conditions and treatment options. Only they can provide personalized medical advice based on your individual situation.