Wyatt K M, Dimmock P W, O'Brien P M
Exeter and North Devon RDSU, Royal Devon and Exeter Hospital, 1st Noy Scott House, Haldon View Terrace, Wonford, Exeter, Devon, UK, EX2 5EQ.
Cochrane Database Syst Rev. 2002(4):CD001396. doi: 10.1002/14651858.CD001396.
Severe premenstrual syndrome affects between 3-5% of women of reproductive age. Such severe PMS is classified under the Diagnostic and Statistical Manual of Mental Disorders as premenstrual dysphoric disorder, PMDD. Selective serotonin reuptake inhibitors (SSRIs) are increasingly being used as a front-line therapy for premenstrual syndrome (PMS). A systematic review was undertaken on the efficacy of SSRIs in the management of severe PMS/PMDD, to assess the evidence for this treatment option.
The objective of this review was to evaluate the effectiveness of SSRIs in reducing premenstrual syndrome symptoms in women diagnosed with severe premenstrual syndrome.
Electronic searches for relevant randomised controlled trials of the Cochrane Menstrual Disorders and Subfertility Group specialised register of controlled trials, Cochrane Controlled Trials Register, MEDLINE, EMBASE and PsychLit were undertaken. References were searched interactively to identify missed trials. Where insufficient data were presented original authors were contacted for further details.
All trials were considered in which women with a prospective diagnosis of PMS/ PMDD were randomised to receive SSRIs or placebo in a double blind trial for the treatment of premenstrual syndrome.
31 randomised controlled trials were identified which reported the use of SSRIs in the management of PMS. 16 trials were excluded, 15 trials were included in the systematic review, and ten trials were included in the main analyses. The reviewers extracted the data independently and standardised mean differences for continuous outcomes were estimated from the data.
The primary analysis of reduction in overall symptomatology included data on 844 women with premenstrual syndrome. SSRIs were found to be highly effective in treating premenstrual symptoms. Secondary analysis showed that they were as effective in treating physical as well as behavioural symptoms. There was no significant difference between trials funded by pharmaceutical companies and those independently funded. Withdrawals due to side effects were 2.5 times more likely to occur in the treatment group, particularly at higher doses.
REVIEWER'S CONCLUSIONS: There is now very good evidence to support the use of selective serotonin reuptake inhibitors in the management of severe premenstrual syndrome.
严重经前综合征影响3%至5%的育龄妇女。这种严重的经前综合征在《精神疾病诊断与统计手册》中被归类为经前烦躁障碍（PMDD）。选择性5-羟色胺再摄取抑制剂（SSRIs）越来越多地被用作经前综合征（PMS）的一线治疗方法。对SSRIs治疗严重经前综合征/经前烦躁障碍的疗效进行了系统评价，以评估这一治疗选择的证据。
本评价的目的是评估SSRIs对诊断为严重经前综合征的女性减轻经前综合征症状的有效性。
对Cochrane月经紊乱与生育力低下小组专门的对照试验注册库、Cochrane对照试验注册库、MEDLINE、EMBASE和PsychLit中相关的随机对照试验进行电子检索。交互式检索参考文献以识别遗漏的试验。若数据不足，则与原始作者联系以获取更多细节。
纳入所有前瞻性诊断为经前综合征/经前烦躁障碍的女性在双盲试验中被随机分配接受SSRIs或安慰剂治疗经前综合征的试验。
识别出31项报告使用SSRIs治疗经前综合征的随机对照试验。排除16项试验，15项试验纳入系统评价，10项试验纳入主要分析。评价者独立提取数据，并根据数据估计连续结果的标准化均数差。
对总体症状减轻的初步分析纳入了844例经前综合征女性的数据。发现SSRIs在治疗经前症状方面非常有效。二次分析表明，它们在治疗身体症状和行为症状方面同样有效。由制药公司资助的试验和独立资助的试验之间没有显著差异。治疗组因副作用而退出的可能性是对照组的2.5倍，尤其是在高剂量时。
现在有非常充分的证据支持使用选择性5-羟色胺再摄取抑制剂治疗严重经前综合征。
