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Zoloft For PMDD: Dosage, Side Effects, and More

Kristin Hall

Medically reviewed by Kristin Hall, FNP

Written by Our Editorial Team

Last updated 10/9/2022

Over 90 percent of women experience premenstrual syndrome (PMS) — emotional and physical symptoms that can involve feelings of irritability, sadness and reduced interest in certain parts of life.

For some women though, these premenstrual symptoms are much more severe. In some cases, these symptoms could be a condition called premenstrual dysphoric disorder (PMDD).

Fortunately, the antidepressant Zoloft® is available as a treatment option for premenstrual dysphoric disorder. 

Below, we’ve explained everything you need to know on how to take Zoloft for PMDD, including dosage, side effects and more.

The Basics of PMDD

Premenstrual dysphoric disorder is a more severe form of premenstrual symptoms. It affects up to eight percent of women between the ages of 16 and 49 years old.

PMDD can cause anxiety, a depressed mood or severe irritability, among other symptoms.

Premenstrual dysphoric disorder starts one or two weeks before your period, and symptoms usually go away two or three days after your period starts.

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.

Emotional or psychological symptoms include:

  • Loss of interest in activities

  • Feeling out of control

  • Nervousness

  • Anger or irritability

  • Severe anxiety

  • Depression or depressive episodes

  • Severe mood swings

  • Feeling sad, hopeless or despair

  • Crying spells

  • Fatigue or lack of energy

  • Paranoia

  • Thoughts of suicide

The physical symptoms of PMDD include:

  • Bloating

  • Back pain

  • Joint or muscle pain

  • Cramps

  • Headache

  • Acne

  • Breast swelling or tenderness 

  • Dizziness

  • Nausea or vomiting 

  • Constipation

  • Fast-beating or racing heart

  • Appetite changes

  • Reduced sex drive

  • Painful periods

While the symptoms of premenstrual dysphoric disorder may be similar to premenstrual symptoms, it should be noted that symptoms of PMDD are much more severe and debilitating. These symptoms can affect your ability to function in relationships, work and daily life.

Although the exact cause is unknown, you may be more likely to develop premenstrual dysphoric disorder if you have anxiety, a depressive disorder, PMS or a family history of PMS, PMDD or mood disorders.

Our guide to premenstrual dysphoric disorder goes over more details of this severe condition.

There are several ways to treat PMDD, including the use of an antidepressant medication like Zoloft.

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Overview of Zoloft

Zoloft is the brand name of sertraline.

This medication belongs to a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs).

Sertraline is used to treat major depression, as well as certain anxiety disorders like obsessive-compulsive disorder, social anxiety disorder, post-traumatic stress disorder and panic attacks.

Zoloft may be used to treat bipolar disorder, but it can increase the risk of becoming manic.

Sertraline works by increasing levels of serotonin, a neurotransmitter that regulates mood and other functions like energy level, sex drive and mental focus.

Be sure to let your healthcare provider know about any other medications you’re taking, as there can be adverse effects or drug interactions. Medications that can have negative drug interactions with Zoloft include monoamine oxidase inhibitors (MAOIs), pimozide (Orap®) or disulfiram (Antabuse®) with sertraline in liquid form.

Additionally, you should let your health care provider know about any new or persisting side effects while taking Zoloft.

Keep reading to learn how to take Zoloft for PMDD.

Zoloft for PMDD

If you deal with premenstrual dysphoric disorder, you may be wondering how treatment with sertraline works.

The FDA has approved Zoloft, along with another SSRI called fluoxetine (Prozac®), for PMDD treatment.

In a study, sertraline was effective in improving over 240 women's ability to better engage in relationships and function in daily activities compared to a placebo throughout three menstrual cycles.

Dosage for PMDD

A common dose of Zoloft for a depressive disorder is 50mg a day, with the maximum being 150mg per day. The typical starting Zoloft dosage for social anxiety disorder, panic disorder and post-traumatic stress disorder is 25mg a day.

For treating premenstrual dysphoric disorder, research has found Zoloft to be an effective treatment in two ways: either daily or intermittent dosing.

For continuous daily intake, the recommended starting dosage is 50mg per day, with a maximum dosage of 150mg per day if your symptoms persist.

Taking an SSRI like sertraline daily was found to start treating PMDD in a matter of days, a much more rapid response than 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, which is the last two weeks of your cycle, after ovulation and before your period starts.

For intermittent dosing of Zoloft for PMDD, the starting dose is 50mg a day during the luteal phase only, which typically starts 14 days before your period.

If your symptoms don’t respond, a healthcare provider will have you take 50mg the first three days of intermittent dosing, then a maximum of 100mg 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, with 63 percent of women taking sertraline showing sustained improvements throughout three menstrual cycles.

Since PMDD symptoms last for a week or two, another possible treatment method is symptom-onset dosing, or using sertraline when PMDD symptoms start.

Only one large placebo-controlled clinical trial has been done to look at the effects of symptom-onset dosing with sertraline compared to those of a placebo.

Throughout six menstrual cycles, almost half of a group of over 250 women were given sertraline when their symptoms began while the other half were given a placebo. Symptoms ofPMDD improved in the treatment group compared to the placebo group, especially in regards to anger or irritability symptoms.

However, the improvement in PMDD symptoms was not as large as it was in studies looking at using sertraline daily or during the luteal phase.

Side Effects

Like any medication, Zoloft can cause side effects. Common side effects of Zoloft include:

  • Nausea

  • Fast-beating heart

  • Dry mouth

  • Nausea

  • Diarrhea

  • Vomiting

  • Decreased appetite

  • Fatigue

  • Tremor

  • Drowsiness

  • Dizziness

  • Insomnia

  • Sexual side effects such as decreased libido

While rare, more serious side effects are possible and include:

  • Unusual bleeding

  • Seizures

  • Swelling

  • Trouble breathing

  • Hallucinations

  • Confusion or memory problems

If you experience any of these severe side effects, contact a healthcare professional immediately.

A study found that women doing intermittent luteal phase sertraline treatment experienced more headaches, nausea, dry mouth and insomnia than those taking a placebo. 

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Getting Treatment for PMDD

Premenstrual dysphoric disorder is a severe premenstrual syndrome that can have a serious impact on your health, well-being and quality of life. Fortunately, there are treatment options, including the antidepressant Zoloft.

If you believe you might have PMDD, you can connect with a mental health provider online to discuss your symptoms and see if a medication like sertraline is the right treatment for you. 

13 Sources

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.

  1. Premenstrual syndrome (PMS). (2021, February 22). Office on Women's Health. Retrieved from https://www.womenshealth.gov/menstrual-cycle/premenstrual-syndrome |
  2. Mishra, S., Elliott, H., & Marwaha, R. (2022, May 5). Premenstrual Dysphoric Disorder - StatPearls. NCBI. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK532307/ |
  3. Premenstrual dysphoric disorder (PMDD). (2021, February 22). Office on Women's Health. Retrieved from https://www.womenshealth.gov/menstrual-cycle/premenstrual-syndrome/premenstrual-dysphoric-disorder-pmdd |
  4. Premenstrual Dysphoric Disorder (PMDD). (n.d.). Johns Hopkins Medicine. Retrieved from https://www.hopkinsmedicine.org/health/conditions-and-diseases/premenstrual-dysphoric-disorder-pmdd |
  5. Premenstrual Dysphoric Disorder: Symptoms & Treatment. (2020, November 23). Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/articles/9132-premenstrual-dysphoric-disorder-pmdd |
  6. Sertraline. (2022, January 15). MedlinePlus. Retrieved from https://medlineplus.gov/druginfo/meds/a697048.html |
  7. Sertraline (Zoloft). (n.d.). NAMI. Retrieved from https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Sertraline-(Zoloft) |
  8. Bhatia, S. C., & Bhatia, S. K. (2002). Diagnosis and Treatment of Premenstrual Dysphoric Disorder. Am Fam Physician, 66(7), 1239-1249. Retrieved from https://www.aafp.org/pubs/afp/issues/2002/1001/p1239.html |
  9. Pearlstein, T. B., Halbreich, U., Batzar, E. D., Brown, C. S., Endicott, J., Frank, E., Freeman, E. W., Harrison, W. M., Haskett, R. F., Stout, A. L., & Yonkers, K. A. (2000). Psychosocial functioning in women with premenstrual dysphoric disorder before and after treatment with sertraline or placebo. The Journal of clinical psychiatry, 61(2), 101–109. Retrieved from https://pubmed.ncbi.nlm.nih.gov/10732657/ |
  10. ZOLOFT (sertraline hydrochloride) Label. (n.d.). Accessdata.fda.gov. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/019839S74S86S87_20990S35S44S45lbl.pdf |
  11. PMDD and Serotonin Reuptake Inhibitors: Does Symptom-Onset Dosing Work? (2015, October 13). MGH Center for Women's Mental Health. Retrieved from https://womensmentalhealth.org/posts/pmdd-and-serotonin-reuptake-inhibitors-does-symptom-onset-dosing-work/ |
  12. Walling, A. D. (2003). Intermittent Sertraline in Women with Severe PMDD. Am Fam Physician, 67(5), 1077-1078. Retrieved from https://www.aafp.org/pubs/afp/issues/2003/0301/p1077.html |
  13. Yonkers KA, Kornstein SG, Gueorguieva R, Merry B, Van Steenburgh K, Altemus M. (2015). Symptom-Onset Dosing of Sertraline for the Treatment of Premenstrual Dysphoric Disorder: A Randomized Clinical Trial. JAMA Psychiatry. 72(10):1037–1044. Retrieved from https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2436278 |

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.

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