Premenstrual dysphoric disorder treatment options include which of the following as first-line pharmacotherapy?

• A. NSAIDs
• B. Diuretics
• C. SSRIs
• D. Hormonal contraceptives

Answer: (C)

SSRIs are the first-line pharmacotherapy for premenstrual dysphoric disorder because they reliably and rapidly reduce the affective symptoms that define PMDD—like depressed mood, irritability, anger, and anxiety—based on multiple randomized trials and guideline recommendations. Serotonin reuptake inhibitors such as fluoxetine, sertraline, and paroxetine have strong evidence for improving mood symptoms and overall functioning in the luteal phase or with continuous dosing. They’re effective relatively quickly, and dosing can be tailored: you can use continuous dosing to suppress symptoms across cycles or luteal-phase dosing to target the weeks before menses, often with good tolerability.

Other options mainly address non-mood symptoms: NSAIDs help cramps and physical discomfort but don’t meaningfully reduce mood symptoms; diuretics address bloating but not the core emotional symptoms; hormonal contraceptives may help some patients but aren’t consistently effective for PMDD and are therefore not the preferred first-line treatment.