Zoloft for PMDD: Dosage, Side Effects, and More

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.

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.

PMDD vs. PMS and Depression

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.

Getting Diagnosed With PMDD

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

• Obsessive-compulsive disorder (OCD)

• Social anxiety disorder

• Post-traumatic stress disorder (PTSD)

• Panic disorder

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.

Continuous Daily Dosing of Zoloft for PMDD

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.

Intermittent Luteal Phase Dosing of Zoloft for PMDD

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.

Symptom-Onset Intermittent Dosing of Zoloft for PMDD

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 Treatment of PMDD

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.

Other Antidepressants and Anti-anxiety Medications for PMDD

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.

Lifestyle Adjustments That May Help PMDD

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.