Intermittent selective serotonin reuptake inhibitors for premenstrual syndromes: A systematic review and meta-analysis of randomised trials

Thomas J. Reilly; Phoebe Wallman; Ivana Clark; Clare Louise Knox; Michael C. Craig; David Taylor

doi:10.1177/02698811221099645

Intermittent selective serotonin reuptake inhibitors for premenstrual syndromes: A systematic review and meta-analysis of randomised trials

Thomas J. Reilly^*, Phoebe Wallman, Ivana Clark, Clare Louise Knox, Michael C. Craig, David Taylor

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

6 Citations (Scopus)

Abstract

Background: Intermittent (luteal phase) dosing of selective serotonin reuptake inhibitors is one treatment strategy for premenstrual syndromes such as premenstrual dysphoric disorder. This avoids the risk of the antidepressant withdrawal syndrome associated with long-term continuous dosing. Aims: To compare intermittent dosing to continuous dosing in terms of efficacy and acceptability. Methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycINFO, PubMed and CINAHL for randomised trials of intermittent compared with continuous dosing of selective serotonin reuptake inhibitors in premenstrual syndromes. We extracted response rates, dropout rates and changes in symptom scores. We used random effects meta-analyses to pool study-level data and calculated odds ratio for dichotomous data and standardised mean difference for continuous data. Risk of bias was assessed using the Cochrane risk-of-bias tool. The study was registered with PROSPERO (CRD42020224176). Results: A total of 1841 references were identified, with eight studies being eligible for analysis, consisting of a total of 460 participants. All included studies provided response rates, six provided dropout rates and five provided symptom scores. There was no statistically significant differences between intermittent and continuous dosing in terms of response rate (odds ratio: 1.0, 95% confidence interval (CI): 0.23–4.31, I² = 71%), dropout rate (odds ratio 1.26, 95% CI: 0.39–4.09, I² = 33%) or symptom change (standardised mean difference: 0.04, 95% CI: −0.27 to 0.35, I² = 39%). All studies had a moderate or high risk of bias. Conclusion: Since intermittent dosing avoids the potential for withdrawal symptoms, it should be considered more commonly in this patient population.

Original language	English
Journal	Journal of Psychopharmacology
DOIs	https://doi.org/10.1177/02698811221099645
Publication status	Accepted/In press - 2022

Keywords

meta-analysis
Premenstrual dysphoric disorder
premenstrual syndrome
randomised controlled trial
serotonin uptake inhibitors

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1177/02698811221099645

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@article{725a6276842b43e3bec4abf2b3c0fcf9,

title = "Intermittent selective serotonin reuptake inhibitors for premenstrual syndromes: A systematic review and meta-analysis of randomised trials",

abstract = "Background: Intermittent (luteal phase) dosing of selective serotonin reuptake inhibitors is one treatment strategy for premenstrual syndromes such as premenstrual dysphoric disorder. This avoids the risk of the antidepressant withdrawal syndrome associated with long-term continuous dosing. Aims: To compare intermittent dosing to continuous dosing in terms of efficacy and acceptability. Methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycINFO, PubMed and CINAHL for randomised trials of intermittent compared with continuous dosing of selective serotonin reuptake inhibitors in premenstrual syndromes. We extracted response rates, dropout rates and changes in symptom scores. We used random effects meta-analyses to pool study-level data and calculated odds ratio for dichotomous data and standardised mean difference for continuous data. Risk of bias was assessed using the Cochrane risk-of-bias tool. The study was registered with PROSPERO (CRD42020224176). Results: A total of 1841 references were identified, with eight studies being eligible for analysis, consisting of a total of 460 participants. All included studies provided response rates, six provided dropout rates and five provided symptom scores. There was no statistically significant differences between intermittent and continuous dosing in terms of response rate (odds ratio: 1.0, 95% confidence interval (CI): 0.23–4.31, I2 = 71%), dropout rate (odds ratio 1.26, 95% CI: 0.39–4.09, I2 = 33%) or symptom change (standardised mean difference: 0.04, 95% CI: −0.27 to 0.35, I2 = 39%). All studies had a moderate or high risk of bias. Conclusion: Since intermittent dosing avoids the potential for withdrawal symptoms, it should be considered more commonly in this patient population.",

keywords = "meta-analysis, Premenstrual dysphoric disorder, premenstrual syndrome, randomised controlled trial, serotonin uptake inhibitors",

author = "Reilly, {Thomas J.} and Phoebe Wallman and Ivana Clark and Knox, {Clare Louise} and Craig, {Michael C.} and David Taylor",

note = "Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: TJR was funded by the NIHR Maudsley Biomedical Research Centre. This study represents independent research part funded by the NIHR Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King{\textquoteright}s College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Publisher Copyright: {\textcopyright} The Author(s) 2022.",

year = "2022",

doi = "10.1177/02698811221099645",

language = "English",

journal = "Journal of Psychopharmacology",

issn = "0269-8811",

publisher = "SAGE Publications Ltd STM",

}

TY - JOUR

T1 - Intermittent selective serotonin reuptake inhibitors for premenstrual syndromes

T2 - A systematic review and meta-analysis of randomised trials

AU - Reilly, Thomas J.

AU - Wallman, Phoebe

AU - Clark, Ivana

AU - Knox, Clare Louise

AU - Craig, Michael C.

AU - Taylor, David

N1 - Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: TJR was funded by the NIHR Maudsley Biomedical Research Centre. This study represents independent research part funded by the NIHR Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Publisher Copyright: © The Author(s) 2022.

PY - 2022

Y1 - 2022

N2 - Background: Intermittent (luteal phase) dosing of selective serotonin reuptake inhibitors is one treatment strategy for premenstrual syndromes such as premenstrual dysphoric disorder. This avoids the risk of the antidepressant withdrawal syndrome associated with long-term continuous dosing. Aims: To compare intermittent dosing to continuous dosing in terms of efficacy and acceptability. Methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycINFO, PubMed and CINAHL for randomised trials of intermittent compared with continuous dosing of selective serotonin reuptake inhibitors in premenstrual syndromes. We extracted response rates, dropout rates and changes in symptom scores. We used random effects meta-analyses to pool study-level data and calculated odds ratio for dichotomous data and standardised mean difference for continuous data. Risk of bias was assessed using the Cochrane risk-of-bias tool. The study was registered with PROSPERO (CRD42020224176). Results: A total of 1841 references were identified, with eight studies being eligible for analysis, consisting of a total of 460 participants. All included studies provided response rates, six provided dropout rates and five provided symptom scores. There was no statistically significant differences between intermittent and continuous dosing in terms of response rate (odds ratio: 1.0, 95% confidence interval (CI): 0.23–4.31, I2 = 71%), dropout rate (odds ratio 1.26, 95% CI: 0.39–4.09, I2 = 33%) or symptom change (standardised mean difference: 0.04, 95% CI: −0.27 to 0.35, I2 = 39%). All studies had a moderate or high risk of bias. Conclusion: Since intermittent dosing avoids the potential for withdrawal symptoms, it should be considered more commonly in this patient population.

AB - Background: Intermittent (luteal phase) dosing of selective serotonin reuptake inhibitors is one treatment strategy for premenstrual syndromes such as premenstrual dysphoric disorder. This avoids the risk of the antidepressant withdrawal syndrome associated with long-term continuous dosing. Aims: To compare intermittent dosing to continuous dosing in terms of efficacy and acceptability. Methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycINFO, PubMed and CINAHL for randomised trials of intermittent compared with continuous dosing of selective serotonin reuptake inhibitors in premenstrual syndromes. We extracted response rates, dropout rates and changes in symptom scores. We used random effects meta-analyses to pool study-level data and calculated odds ratio for dichotomous data and standardised mean difference for continuous data. Risk of bias was assessed using the Cochrane risk-of-bias tool. The study was registered with PROSPERO (CRD42020224176). Results: A total of 1841 references were identified, with eight studies being eligible for analysis, consisting of a total of 460 participants. All included studies provided response rates, six provided dropout rates and five provided symptom scores. There was no statistically significant differences between intermittent and continuous dosing in terms of response rate (odds ratio: 1.0, 95% confidence interval (CI): 0.23–4.31, I2 = 71%), dropout rate (odds ratio 1.26, 95% CI: 0.39–4.09, I2 = 33%) or symptom change (standardised mean difference: 0.04, 95% CI: −0.27 to 0.35, I2 = 39%). All studies had a moderate or high risk of bias. Conclusion: Since intermittent dosing avoids the potential for withdrawal symptoms, it should be considered more commonly in this patient population.

KW - meta-analysis

KW - Premenstrual dysphoric disorder

KW - premenstrual syndrome

KW - randomised controlled trial

KW - serotonin uptake inhibitors

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U2 - 10.1177/02698811221099645

DO - 10.1177/02698811221099645

M3 - Review article

C2 - 35686687

AN - SCOPUS:85131756037

SN - 0269-8811

JO - Journal of Psychopharmacology

JF - Journal of Psychopharmacology

ER -

Intermittent selective serotonin reuptake inhibitors for premenstrual syndromes: A systematic review and meta-analysis of randomised trials

Abstract

Keywords

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