A woman considers Prozac for PMDD.

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Considering Prozac for PMDD? Read This

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Written By: Ashley Laderer

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Clinically Reviewed By: Dr. Eli Muhrer

October 10, 2024

7 min.

Should you take Prozac for PMDD? Read on to learn more about PMDD and how the antidepressant Prozac can help.

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The menstrual cycle, in general, is no fun. And for people with premenstrual dysphoric disorder (PMDD), certain points of the menstrual cycle are debilitating. Experts estimate that 6% of women of reproductive age deal with PMDD symptoms every month. 

Many people are familiar with premenstrual syndrome (PMS), but PMDD is less well-known. “PMDD is a severe form of PMS characterized by intense emotional and physical symptoms that occur during the luteal phase of the menstrual cycle –– typically one to two weeks before menstruation,” says Meghan Jensen, LPC, a Charlie Health Primary Therapist.

If you have premenstrual dysphoric disorder, you don’t have to suffer. Medications such as Prozac (fluoxetine) can help relieve symptoms and make the luteal phase much more bearable. Here’s what you need to know about taking Prozac for PMDD, including dosage information, side effects, and other treatment options.

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Premenstrual dysphoric disorder and Prozac 

First, it is important to understand exactly what PMDD is. While all menstruating people experience fluctuating levels of hormones (such as estrogen and progesterone) throughout their cycle, it’s believed that people with PMDD may have an unusual reaction to these fluctuations, leading to PMDD symptoms. These hormonal changes are hypothesized to cause drops in serotonin, which is a brain chemical that plays a strong role in many anxiety and mood disorders. 

“PMDD can significantly impact a person’s quality of life, both mentally and physically,” Jensen says. “The symptoms often disrupt daily functioning and relationships.” These symptoms can include mental symptoms like depression, mood swings, and irritability, plus physical symptoms like fatigue, headaches, changes to appetite, and more. PMDD symptoms pop up during the luteal phase (one or two weeks before your period) and subside quickly after your period starts. 

Since PMDD symptoms can majorly impact functioning and quality of life, many people seek treatment for it. One medical treatment option for PMDD is Prozac, the brand name for fluoxetine. “Prozac is a selective serotonin reuptake inhibitor (SSRI) that can help reduce symptoms of PMDD by increasing the levels of serotonin in the brain,” says Dr. Eli Muhrer, M.D., a board-certified Child and Adolescent Psychiatrist with Charlie Health. “Serotonin plays a key role in mood regulation, and for individuals with PMDD, hormonal fluctuations can decrease serotonin levels, leading to severe mood swings, irritability, and depression.”

Essentially, Prozac can help to balance the impact of the hormonal changes on serotonin that occur during the luteal phase, stabilizing mood changes and improving PMDD symptoms, Dr. Muhrer says. 

Dosage recommendations for Prozac in treating PMDD

“The typical dosage of Prozac for PMDD treatment varies based on individual needs, but a common starting point is 10 milligrams to 20 milligrams daily,” says Dr. Muhrer. Depending on the severity of symptoms and how an individual responds to the medication, the dose can go up to 30 or 40 milligrams a day, he adds. 

Prozac is a versatile antidepressant, and there are two ways to use it for premenstrual dysphoric disorder treatment, Dr. Muhrer says. The first is intermittent or “luteal” dosing, which is when you only take Prozac during the luteal phase, AKA the symptomatic phase of the menstrual cycle for people with PMDD. The other involves continuous daily usage, meaning taking Prozac every day. Psychiatrists may especially recommend this approach if you have co-occurring mental health conditions such as major depressive disorder (MDD) or an anxiety disorder (such as panic disorder or generalized anxiety disorder. When taking Prozac daily, your psychiatrist may recommend increasing the dose during the luteal phase. 

Dr. Muhrer says both approaches have been shown to significantly reduce PMDD symptoms. Your provider will determine which approach is most appropriate for your individual circumstances. Various studies have been conducted to evaluate the effectiveness of fluoxetine for PMDD. Researchers have found that Prozac is effective for relieving PMDD symptoms, and that it its effects kick in rather rapidly. Studies have suggested that 20 miligrams a day of Prozac is effective and tolerable –– with any side effects only lasting short-term. 

Prozac side effects

As with any other medication, selective serotonin reuptake inhibitors like fluoxetine come along with the risk of side effects. Common side effects of Prozac include:

  • Nausea and diarrhea
  • Anxiety, shaking/trembling, and sweating
  • Trouble sleeping
  • Dry mouth
  • Loss of appetite and weight loss
  • Headache
  • Weakness
  • Sexual dysfunction (lowered libido, trouble orgasming)

Side effects are typically most pronounced when you first start taking the medication, and then they subside within a few weeks. There are also a couple of serious possible risks associated with Prozac, as follows:

Increased risk of suicidal thoughts

Antidepressants, including any selective serotonin reuptake inhibitor, have the potential to cause new or worsening suicidal thoughts or behaviors, especially in teens and young adults 24 and under. This is rare, but it’s important to know so you can monitor for warning signs.

Serotonin syndrome

Selective serotonin reuptake inhibitors (SSRIs) also come along with the risk of serotonin syndrome, which is when your body has dangerously high serotonin levels. Symptoms range from mild (diarrhea, vomiting, dilated pupils) to severe (rapid or abnormal heart rate, confusion, high fever, seizures). This is a medical emergency. Contact your doctor immediately if you have any signs of serotonin syndrome. 

Other medication options for PMDD

If Prozac isn’t the right fit for you, there are a few other options for PMDD treatment, including:

  • Other SSRI antidepressants that are effective for PMDD treatment such as Zoloft (sertraline) and Paxil (paroxetine), Dr. Muhrer says. These medications work the same way as Prozac, increasing levels of the neurotransmitter serotonin. 
  • Hormonal birth control (oral contraceptives) can regulate the hormonal fluctuations responsible for PMDD symptoms, says Dr. Muhrer.
  • Gonadotropin-releasing hormone (GnRH) agonists are another hormonal treatment option, especially for those with severe PMDD, Dr. Muhrer says. These medications alter the menstrual cycle by suppressing ovulation. 

Non-pharmaceutical treatments for PMDD

There are many other things you can do to relieve PMDD symptoms, as follows:

Therapy for PMDD

Lifestyle changes for PMDD

  • Cognitive behavioral therapy for reframing negative thought patterns
  • Dialectical behavior therapy for improving emotional regulation
  • Consistent exercise, eating, and mindfulness practices
  • Creative expression
  • Self-compassion

Therapy for PMDD

Therapy is a great tool no matter what mental health concern you’re dealing with. One type of therapy that is particularly helpful for PMDD is cognitive behavioral therapy or CBT.

“CBT helps individuals reframe negative thought patterns and develop healthier ways to cope with emotional distress,” Jensen says. “For someone with PMDD, CBT can be useful in managing mood swings, irritability, and depressive episodes by identifying triggers, understanding their emotional responses, and implementing strategies for distress tolerance.”

Dialectical behavior therapy (DBT) is also helpful for people with PMDD. Jensen says DBT skills such as emotional regulation and distress tolerance can help you cope with PMDD symptoms. DBT also teaches interpersonal effectiveness, which is helpful if your PMDD has caused turmoil in your relationships. 

Lifestyle changes for PMDD

Lifestyle changes can improve your overall health, wellness, and PMDD symptoms. Here are some recommended lifestyle changes:

1. Get regular exercise

“Regular physical activity can help regulate hormones and improve mood,” Jensen says. This is because exercise releases feel-good hormones in your body, such as endorphins, which are natural mood boosters. This can help counteract the depressive symptoms associated with PMDD.

2. Eat a healthy, balanced diet

Make sure your body is getting all the nutrients it needs.  You might also want to consider making some adjustments to your diet, such as reducing caffeine and sugar to help stabilize mood swings and reduce irritability, Jensen says.

3. Practice mindfulness

Mindfulness is a skill that helps improve mental health. It involves being fully present in the moment, accepting things as they are without judgment. “Mindfulness practices help you stay grounded during periods of emotional upheaval,” says Jensen. You can try mindfulness techniques like diaphragmatic breathing (deep belly breathing), body scanning, or guided imagery when you’re feeling stressed or extra emotional. 

4. Have a routine

Creating a structured routine can provide you with a sense of stability when emotions feel out of control, Jensen says. “Having a consistent sleep schedule, balanced meals, and time for relaxation can help manage the unpredictable mood swings of PMDD,” she explains. 

5. Express yourself

Getting creative and creating some kind of art can help you express your emotions in different ways. “Sometimes emotional distress can be lessened by engaging in creative outlets such as journaling, painting, or music,” Jensen says. “These activities allow for emotional release without needing to process or ‘fix’ emotions in the moment.”

6. Practice self-compassion

Self-compassion refers to treating yourself with love and speaking to yourself the way you would to a loved one. This includes speaking kindly to yourself and accepting that your symptoms are part of a mental health condition –– not a personal failing, Jensen says. 

A woman sits on a couch with PMDD.

How Charlie Health can help

If you’re struggling with premenstrual dysphoric disorder (PMDD), Charlie Health is here to help. Our virtual Intensive Outpatient Program (IOP) provides personalized mental health treatment for individuals with serious mental health conditions, including PMDD and co-occurring conditions. 

Our clinicians incorporate evidence-based therapies into individual counseling, family therapy, and group sessions. We also offer medication management as necessary, which means a provider can prescribe medication for PMDD if they believe it’s the right fit for you. Fill out the form below or call us to start your recovery journey today.

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