Lexapro For PMDD: What Are The Benefits?

Premenstrual dysphoric disorder, or PMDD, is a frustrating mental health condition. Fortunately, effective treatment options are out there, including antidepressants like Lexapro®.

If you’ve been diagnosed with this mood disorder or you’ve been struggling to manage it, a healthcare provider might have suggested Lexapro for PMDD.

Managing PMDD is like treating any other mental health condition. It may take time to see results, it might call for a combination of treatments, and it could take more than one try to find the right combo for your needs.

If you’re curious to learn more about Lexapro and how it might treat PMDD, you’re in the right place. We’ll break down the basics of PMDD, explain how Lexapro works, and explore other treatment options.

Let’s start with the essentials.

Premenstrual dysphoric disorder is a relatively new diagnostic term and mood disorder. The simplest way to understand it is as a specific name for the most severe premenstrual symptoms — or premenstrual syndrome (PMS).

PMDD is essentially a collection of physical symptoms, depressive symptoms, and anxiety symptoms interlinked with the menstrual cycle.

The symptoms of PMDD can be physical, emotional, or psychological. For a diagnosis, you’ll typically have several of the following symptoms:

• Depressed mood

• Hopelessness

• Anxiety

• Irritability

• Decreased interest in activities

• Difficulty concentrating

• Fatigue

• Changes in appetite (like intense food cravings)

• Sleep issues

• Feeling overwhelmed or out of control

• Breast tenderness or swelling

• Headaches

• Bloating

• Weight gain

• Joint or muscle pain

With PMDD, these symptoms are generally strong enough to interfere with your ability to function in professional and social settings and affect your overall quality of life.

Crucially, PMDD is the diagnosis you’d get when the above symptoms are related to your cycle.

So, where does Lexapro enter the equation? While it’s only FDA-approved to treat major depressive disorder (MDD) and generalized anxiety disorder (GAD), Lexapro is sometimes prescribed off-label to help treat PMDD, partially thanks to its mood-regulating benefits.

Off-label is when a medication is prescribed to treat something it’s not FDA-approved for.

What is Lexapro, exactly? It’s a selective serotonin reuptake inhibitor (SSRI) — an antidepressant medication. The active ingredient in Lexapro is escitalopram.

When taken as directed, it can help treat some symptoms of depression, anxiety, and other mental illnesses by helping your brain better regulate the activity of serotonin. Serotonin is a neurotransmitter that’s thought to play a role in mood regulation.

Certain brain cells produce serotonin, but they also reabsorb it quickly after it’s released into the space where it’s active. Some people with depression or PMDD benefit from Lexapro blocking this reabsorption. In that case, Lexapro might reduce the symptoms associated with PMDD, similarly to other SSRIs.

One study looked at escitalopram for PMDD. It found that, for most of the subjects, the medication provided an 80 percent reduction in some of the most commonly reported symptoms, including irritability and mood changes.

Treatment during the clinical trial was administered during the luteal phase of the menstrual cycle, the period between egg release and menstruation.

The size of the response was also more than double the response in placebo patients, suggesting that Lexapro might be an effective treatment option for PMDD.

The placebo-controlled trial we mentioned in the last section is the most comprehensive and substantial one we’ve found to date.

The more than 150 women who were part of the study were divided into three groups: a placebo group and two escitalopram groups at 10-milligram (mg) and 20-milligram daily doses.

The 20-milligram group saw those great results, while the other group did not. In fact, the study’s authors went so far as to call 20 milligrams a “clearly superior” dosage for treating PMDD.

Twenty milligrams is also the maximum recommended dose of Lexapro.

Those with major depressive disorder tend to start on 10 milligrams and move up in dosage as necessary. The maximum recommended dose for anyone with liver problems is 10 milligrams.

Like all medications, Lexapro comes with the potential for side effects.

Here are the most common Lexapro side effects:

• Nausea

• Headache

• Fatigue

• Dry mouth

• Diarrhea

• Constipation

• Indigestion

• Abdominal pain

• Flu-like symptoms

• Insomnia

• Dizziness

• Sweating

• Sexual performance and libido issues

Serious side effects and risks of taking Lexapro may include:

• Increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults

• Abnormal bleeding (NSAIDs like aspirin and other blood thinners should be used with caution)

• Eye pain and vision problems

• Increased risk of experiencing serotonin syndrome

Also, you shouldn’t abruptly stop taking this prescription medication. Sudden discontinuation of escitalopram could cause withdrawal symptoms like irritability, dizziness, nausea, and anxiety.

It’s crucial to understand that while daily dosing of Lexapro may be an effective treatment for some PMDD symptoms, it’s not approved by the FDA (U.S. Food and Drug Administration) for PMDD treatment.

That said, off-label prescribing is a legal and common practice.

Regardless, it’s helpful to be aware of other treatment options available for PMDD. We’ll highlight a few of them below.

Hormone Treatments

Since PMDD symptoms usually start around ovulation — about one to two weeks before the onset of menses — hormonal treatments like birth control that suppress ovulation might help alleviate PMDD symptoms.

Some hormonal medications include:

• Oral contraceptives. The FDA approves birth control pills containing drospirenone (a hormone) for PMDD treatment. Some healthcare professionals prescribe other birth control pills off-label for the same purpose. Hormonal birth control pills may help reduce PMDD symptoms for some, but how they work — and which ones work best — is still unclear.

• Gonadotropin-releasing hormone (GnRH) agonists. GnRH agonists stop the ovaries from producing estrogen and progesterone. One example is leuprolide, which is used to treat and manage prostate cancer, endometriosis, early puberty, and other medical conditions related to sex hormones.

Although they can be a huge help for PMDD symptoms, GnRH agonists temporarily induce menopause. This could cause PMDD-like symptoms, including anxiety, depression, and trouble concentrating.

Other Antidepressants for PMDD

Lexapro isn’t the only depression and anxiety medication that can be used to treat premenstrual dysphoric disorder.

Other SSRIs include:

• Citalopram (Celexa®)

• Fluoxetine (Prozac®)

• Paroxetine (Paxil®)

• Sertraline (Zoloft®)

Serotonin-norepinephrine reuptake inhibitors (SNRIs) are another kind of antidepressant that acts on serotonin and another neurotransmitter and hormone called norepinephrine. They include:

• Duloxetine (Cymbalta®)

• Venlafaxine (Effexor®)

Some other antidepressants that don’t fit within either of these classes might be effective. However, not as much research has been done to say anything definitively about how well they’ll work for PMDD.

You can do a virtual evaluation with Hers online mental health services to determine whether medication is the right treatment option for you.

Rest assured, treatment of premenstrual dysphoric disorder is possible.

Here’s what to keep in mind about Lexapro and PMDD:

• PMDD is a serious physical and mental health condition that can impact day-to-day life. Some symptoms include depressed mood and hopelessness, anxiety and irritability, sleep issues, and severe PMS symptoms like breast tenderness and bloating.

• Lexapro is an SSRI that modifies serotonin activity in the brain. It’s FDA-approved to treat major depressive disorder and generalized anxiety disorder but is sometimes used off-label to treat PMDD.

• Your tailored treatment plan may require medication or lifestyle changes. Besides Lexapro, treatment options include other SSRIs such as Zoloft or hormone treatments like some forms of oral contraceptives.

• If you have PMDD and are considering Lexapro, get personalized medical advice from a healthcare provider. They’ll be able to answer questions about Lexapro use with medical disorders like PMDD and go over additional risks, side effects, and drug interactions with other meds or supplements you’re taking.

Not sure where to find that kind of support for PMDD? Our online psychiatry platform can connect you with mental health professionals who’ll help you find the right medication for your needs.

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.