Content
Free Mental Health Assessment
Reviewed by Daniel Z. Lieberman, MD
Written by Hadley Mendelsohn
Published 10/08/2022
Updated 09/11/2024
Over 90 percent of women experience premenstrual syndrome (PMS) — emotional and physical symptoms that can involve feelings of irritability, sadness, and anxiety.
For some women, though, these premenstrual symptoms are more severe. In some cases, they could point to a mental health condition called premenstrual dysphoric disorder (PMDD).
Fortunately, there are treatment options for PMDD, like the antidepressant Zoloft® (which contains the active ingredient sertraline). What does Zoloft for PMDD do?
We’ll explain everything you need to know about taking Zoloft for PMDD, including how it works, dosage, side effect information, and more.
Content
Before we dive into the details of how Zoloft can treat PMDD, let’s go over the basics of this mental health condition.
You can think of premenstrual dysphoric disorder as a more severe form of premenstrual symptoms. Classified as a mood disorder, it can cause anxiety, a depressed mood, or severe irritability, among other symptoms.
Women with PMDD may experience both emotional and physical symptoms. Many symptoms of premenstrual dysphoric disorder are similar to the signs of major depression in women.
Psychological and behavioral symptoms of PMDD can include:
Loss of interest in activities
Feeling out of control
Nervousness or severe anxiety
Anger or irritability
Depression or depressive episodes
Severe mood swings (which might involve crying spells)
Feeling sad or hopeless
Difficulty concentrating
Sleep issues
Being on edge or tense
Fatigue or lack of energy
The physical symptoms of PMDD can include:
Bloating
Back pain
Joint or muscle pain
Cramps
Headache
Acne
Breast tenderness or swelling
Dizziness
Nausea or vomiting
Constipation
Fast-beating or racing heart
Appetite changes like increased cravings
Reduced sex drive
Painful periods
If you have several PMDD symptoms and think you may have the condition, get in touch with a healthcare provider about treatment options and medical advice.
While the symptoms of premenstrual dysphoric disorder may be similar to regular premenstrual symptoms, symptoms of PMDD are much more severe and debilitating.
These symptoms can affect your ability to function in relationships, work, and daily life.
PMDD is also distinct from major depressive disorder (MDD) in that the symptoms are tied to your menstrual cycle. Symptoms typically start one or two weeks before your period and go away two or three days after your period starts.
Although the exact cause is unknown, some research suggests you may be more likely to develop PMDD if you have:
Anxiety
Depression
Bipolar
Severe PMS
Rhesus (Rh) negative blood type
A lot of caffeine
A family history of PMS, PMDD, or mood disorders like major depressive disorder
In fact, about half of the women who have PMDD can also have co-occurring depression.
Another study found that PMS and PMDD usually peak in the mid-30s, though it can happen earlier.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), you have to meet the following criteria to get diagnosed with PMDD:
You experience at least five symptoms of PMDD in the final week before your menses for at least two cycles. The symptoms start to get better within a few days of your period and then either go away or get more manageable the week after your period.
At least one of the symptoms needs to be a mood symptom.
The symptoms are severe enough to interfere with daily functioning.
Another mental health condition or disorder isn’t causing the symptoms.
You have documentation of these symptoms and their severity for at least two menstruation cycles.
There are several ways to treat premenstrual dysphoric disorder, including the use of antidepressant medication like Zoloft.
Zoloft is the brand name for the generic antidepressant medication sertraline. This prescription drug belongs to a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs).
Zoloft is one of three SSRIs that’s FDA-approved as a first-line treatment for premenstrual dysphoric disorder.
In addition to PMDD, sertraline is FDA-approved to treat:
Major depression
Zoloft is sometimes also used off-label to treat bipolar disorder, but it can increase the risk of manic episodes.
Sertraline works by increasing activity of serotonin, a neurotransmitter (brain chemical) that regulates mood and other functions, such as energy level, sex drive, and mental focus.
So, how does Zoloft for PMDD work? Let’s dig into it.
If you deal with premenstrual dysphoric disorder, you may be wondering how treatment with sertraline works.
It works in the same way it does for treating other conditions: by helping your brain optimize serotonin levels.
One study found that sertraline effectively improved over 240 women’s ability to engage in relationships and function in daily activities compared to placebo groups throughout three menstrual cycles.
A standard dose of Zoloft for a depressive disorder is 50 milligrams (mg) a day, with the maximum being 150 milligrams per day.
The typical starting Zoloft dosage for PMDD is 50 milligrams a day.
For the treatment of premenstrual dysphoric disorder, research shows that Zoloft can be taken a few ways: daily, symptom-onset, and intermittent dosing. We’ll go over these below.
For continuous daily intake, the recommended starting dosage of Zoloft for PMDD is 50 milligrams per day, with a maximum dosage of 150 milligrams per day if symptoms persist.
In one study, those who took sertraline daily found that it started treating PMDD in a matter of days. That’s a much more rapid response than other SSRIs as a depression treatment, which can take two to four weeks to start working.
Another method of using Zoloft for PMDD is intermittent dosing during the luteal phase of the menstrual cycle. That’s the last two weeks of your cycle, after ovulation and before your period starts.
For intermittent dosing of Zoloft for premenstrual dysphoric disorder, the starting dose is 50 milligrams a day during the luteal phase only.
If your symptoms don’t respond, a healthcare provider might have you take 50 milligrams the first three days of intermittent dosing, then a maximum of 100 milligrams per day during the rest of your dosing period.
One study found that luteal phase sertraline treatment in women with PMDD led to greater relief from symptoms than a placebo. About 63 percent of women taking sertraline showed sustained improvements throughout three menstrual cycles.
Since PMDD symptoms last for a week or two, another possible treatment method is symptom-onset dosing. This means using sertraline when PMDD symptoms start.
In one double-blind, placebo-controlled clinical trial, people who took sertraline when their symptoms started (and then stopped after their cycle) noticed improvement and didn’t have an increased risk of withdrawal symptoms.
The symptoms of anger and irritability seemed to respond to treatment the most. However, the improvement in PMDD symptoms wasn’t as significant as it was in studies looking at using sertraline daily or during the luteal phase.
Like any medication, Zoloft can cause side effects.
Common side effects of Zoloft include:
Nausea, vomiting, or diarrhea
Constipation
Dry mouth
Sweating
Decreased appetite
Drowsiness or fatigue
Dizziness
Insomnia
Sexual side effects such as decreased libido
Although rare, allergic reactions and more serious side effects are possible. These include:
Unusual bleeding
Seizures
Swelling
Trouble breathing
Hallucinations
Confusion or memory problems
If you experience any of these severe side effects, contact a medical professional immediately. You should also let your healthcare provider know about any other new or persisting side effects while taking Zoloft.
Always be sure to let your provider or clinician know about any other medications you’re taking, as there can be adverse effects or dangerous drug interactions.
Medications that can have negative drug interactions with Zoloft include:
Monoamine oxidase inhibitors (MAOIs)
Pimozide (Orap®)
Non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin
Disulfiram (Antabuse®) when sertraline is in liquid form
Also, one study found that women doing intermittent luteal phase sertraline treatment have a higher risk of experiencing more headaches, nausea, dry mouth, and insomnia than those taking a placebo.
While SSRIs like Zoloft are often the first-line treatment for PMDD, there are other treatment options worth knowing about.
Hormonal medications like birth control prevent ovulation from happening. Since that’s when symptoms usually kick in, these treatments may help stop PMDD symptoms.
Some hormonal medications include:
Oral contraceptives. Drospirenone birth control pills are FDA-approved for PMDD treatment. Some healthcare professionals prescribe other types of oral contraceptive pills off-label as well. Hormonal birth control pills might help manage PMDD symptoms for some women, but there needs to be more research to understand how they work and which ones are most effective.
Gonadotropin-releasing hormone (GnRH) agonists. These prevent estrogen and progesterone production in the ovaries. One example of a GnRH agonist is leuprolide, which is used to treat prostate cancer, endometriosis, precocious puberty, and sex hormone-related conditions.
Keep in mind that while they can help quell PMDD symptoms, GnRH agonists temporarily induce menopause, which can cause PMDD-like symptoms, including anxiety and depression.
Zoloft isn’t the only depression and anxiety medication that can treat PMDD.
Other antidepressants that may be prescribed include:
Citalopram (Celexa®)
Escitalopram (Lexapro®)
Paroxetine (Paxil®)
Duloxetine (Cymbalta®)
Fluoxetine (Prozac®)
While other antidepressants may also be effective, not as much research has been done to say anything definitively about how well they’ll work for PMDD.
You can schedule a virtual evaluation with Hers online services to figure out if medication is the right treatment option for you.
Healthy daily habits and lifestyle changes might help with premenstrual dysphoric disorder too. These include:
Exercising. Staying active and making sure you’re getting your heart rate up every day can improve your mood and energy levels. Things like walking, running, swimming, biking, and strength training are all great options.
Eating a healthy diet. Focus on consuming nutritious foods and well-rounded meals.
Relieving stress. Keeping your stress levels in check is always healthy, but it’s easier said than done. Mindfulness meditation and relaxation techniques might be good places to start.
Taking supplements. Certain mood-boosting supplements — like vitamin B6, calcium, and magnesium — and some herbal remedies might benefit people with PMDD.
Premenstrual dysphoric disorder affects up to eight percent of women between the ages of 16 and 49 years old.
This severe form of premenstrual syndrome can have an immense impact on your health, well-being, and quality of life. Fortunately, there are treatment options, including the antidepressant Zoloft.
Here’s what to keep in mind as you navigate this process:
PMDD is generally described as more severe and debilitating premenstrual symptoms.
Symptoms of PMDD can include mood swings, depressed mood, anxiety, feeling hopeless, and physical symptoms, such as headache, bloating, or muscle pain.
SSRIs can be used to treat PMDD, possibly in conjunction with lifestyle changes and therapy.
Zoloft for PMDD can be an effective treatment, with a few options of how you can take it. Your healthcare provider should help you decide on the dosing regimen.
Living with PMDD can be overwhelming and significantly impact your everyday life. And while there’s no single best treatment for PMDD, a combination of approaches can help you manage the symptoms.
If you think you might have PMDD, connect with a mental health provider through our online psychiatry platform to discuss your symptoms and see if a medication like sertraline is the right treatment for you.
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.
Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!
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.
Doctor of Medicine - New York University Grossman School of Medicine, 1992
Bachelor of Arts - St. John’s College, 1985
Internship & Residency - New York University Grossman School of Medicine, 1996
District of Columbia, 1996
Maryland, 2022
Virginia, 2022
American Board of Psychiatry and Neurology, Psychiatry, 1997
American Board of Psychiatry and Neurology, Addiction Psychiatry, 1998
Stanford Online, AI in Healthcare Specialization Certificate, 2025
Stanford Online, Machine Learning Specialization Certificate, 2024
Mental Health
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Professor and Vice Chair - Department of Psychiatry and Behavioral Sciences, George Washington University, 1996–2022
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I practice medicine because I believe that mental health is the foundation of a meaningful life. When people suffer psychologically, it touches every part of their existence—from relationships to work to the simple ability to feel joy. Because it can be so difficult for people who are suffering to find good mental health care, my mission has been to expand access through technology, so that no one is left behind.
I like to write in my spare time. I’ve written two nonfiction titles, Spellbound: Modern Science, Ancient Magic, and the Hidden Potential of the Unconscious Mind and the international bestseller, The Molecule of More: How a Single Chemical in Your Brain Drives Love, Sex, and Creativity--and Will Determine the Fate of the Human Race
danielzlieberman.com