Yonkers Kimberly A, Pearlstein Teri, Fayyad Rana, Gillespie John A
J Affect Disord. 2005 Apr;85(3):317-21. doi: 10.1016/j.jad.2004.10.006.
Despite the proven efficacy of luteal phase medication dosing for women with premenstrual dysphoric disorder (PMDD), it is not known whether this approach adequately treats symptoms that linger into the first 2-3 days of the follicular phase, a time when up to one-third of women diagnosed with PMDD report residual symptoms. Furthermore, no previous study has explored whether abruptly stopping medication after 2 weeks of treatment is associated with discontinuation symptoms.
To evaluate the efficacy of luteal phase medication dosing, symptom data from the Daily Record of Severity of Problems (DRSP) during first few days of menses were compared from two studies with similar designs but different treatment strategies. The first study used continuous dosing of sertraline, 50-150 mg/day, throughout the menstrual cycle, while the second study used intermittent dosing with sertraline, 50-100 mg/day in the 14-16 days prior to onset of menses. To investigate whether abruptly stopping pills led to discontinuation symptoms, DRSP data for the first 5 days after the onset of menses were analyzed in the second (intermittent dosing) study. Symptom scores were compared for subjects who took either sertraline or placebo premenstrually and ceased taking pills at the onset of menses.
The baseline (pretreatment) to on-treatment effect sizes were similar for continuous vs. luteal phase dosing on the first day of menses (0.73 vs. 0.89), second day of menses (0.40 vs. 0.55), and third day of menses (0.42 vs. 0.44), respectively. Subjects who abruptly discontinued sertraline had fewer symptoms indicative of withdrawal at Day 3 (p < 0.01) and no difference during Days 4-5 compared to subjects abruptly discontinuing placebo.
Patients given active medication during the luteal phase demonstrate reductions in DRSP total scores into the first few days of menses regardless of whether active treatment was continuous throughout the menstrual cycle or was discontinued at the onset of menses. This analysis finds no support for discontinuation symptoms following abrupt cessation of sertraline after 2 weeks of treatment for two cycles.
尽管已证实黄体期药物给药对经前烦躁障碍（PMDD）女性有效，但尚不清楚这种方法能否充分治疗持续至卵泡期头2至3天的症状，在此期间，多达三分之一被诊断为PMDD的女性报告有残留症状。此外，以前没有研究探讨过治疗2周后突然停药是否会出现停药症状。
为评估黄体期药物给药的疗效，比较了两项设计相似但治疗策略不同的研究中月经头几天问题严重程度每日记录（DRSP）的症状数据。第一项研究在整个月经周期中持续给予舍曲林，50 - 150毫克/天，而第二项研究在月经开始前14 - 16天给予舍曲林间歇给药，50 - 100毫克/天。为调查突然停药是否会导致停药症状，在第二项（间歇给药）研究中分析了月经开始后前5天的DRSP数据。比较了月经前服用舍曲林或安慰剂且在月经开始时停止服药的受试者的症状评分。
连续给药与黄体期给药在月经第一天（0.73对0.89）、月经第二天（0.40对0.55）和月经第三天（0.42对0.44）的基线（治疗前）至治疗效果大小相似。与突然停用安慰剂的受试者相比，突然停用舍曲林的受试者在第3天出现戒断症状的较少（p < 0.01），在第4 - 5天无差异。
无论在整个月经周期中积极治疗是持续还是在月经开始时停止，在黄体期给予活性药物的患者在月经头几天DRSP总分均会降低。该分析未发现两个周期治疗2周后突然停用舍曲林会出现停药症状的证据。
