Premenstrual dysphoric disorder (PMDD): Suggested daily dosing for continuous and intermittent regimens

SSRI	Starting dose (half suggested effective dose)	Usual effective doses	Maximum after several cycles if further titration is needed for symptom control
Citalopram	10 mg	20 to 30 mg	Continuous: 40 mg Intermittent: 30 mg
Escitalopram	5 to 10 mg	10 to 20 mg	Continuous: 20 mg Intermittent: 20 mg
Fluoxetine	10 mg	20 mg	Continuous: 30 mg Luteal phase: 30 mg Symptom onset: 20 mg
Paroxetine (IR)	10 mg	20 to 30 mg	Continuous: 40 mg Intermittent: 30 mg
Sertraline	25 mg	50 to 150 mg	Continuous: 200 mg Intermittent: 150 mg

Suggestions for dose titration using citalopram as an example:

Starting dose is 10 mg; increase in 10 mg increments as tolerated.
For symptom-onset dosing: Initial: 10 mg once daily from the day of symptom onset until a few days after the start of menses; may further increase dose based on response and tolerability (eg, in 10 mg increments) per menstrual cycle up to a maximum of 30 mg/day.^[1]
For intermittent regimens (luteal phase or symptom-onset): After approximately 6 months, many women are able to accommodate to a higher starting dose (ie, they can initiate each cycle with the ultimate therapeutic dose [20 to 30 mg] rather than the initial 10 mg dose).

SSRI: selective serotonin reuptake inhibitor; IR: immediate release.

Reference:

Ravindran LN, Woods SA, Steiner M, Ravindran AV. Symptom-onset dosing with citalopram in the treatment of premenstrual dysphoric disorder (PMDD): a case series. Arch Womens Ment Health 2007; 10:125.

Courtesy of Kimberly Yonkers, MD.

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