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Letters |

Sertraline for Premenstrual Dysphoric Disorder

Lee S. Cohen, MD
JAMA. 1998;279(5):357-358. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-5-jbk0204.
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To the Editor.— The multicenter study by Dr Yonkers and colleagues1 reported the efficacy of sertraline hydrochloride for patients with premenstrual dysphoric disorder (PMDD). The results of this study are consistent with 6 prior reports of the efficacy of fluoxetine in similar populations.1,2 The authors selected sertraline as an alternative to fluoxetine for treatment of PMDD in part because it "can be started at a low dose." Yet, with respect to initiating treatment, fluoxetine can certainly be first administered at low doses, eg, 10 mg. The authors also speculate that the short half-life of sertraline makes it preferable for women who wish to conceive or who inadvertently conceive. Although the more rapid clearance of sertraline from maternal circulation following documentation of pregnancy offers a potential advantage with respect to limiting total time of fetal exposure,3 nearly 50% of women who conceive do so inadvertently and present well into the first trimester.4 At this point, fetal exposure to sertraline is of concern given the dearth of systematic information regarding the safety of this agent during pregnancy. In contrast, there are 1100 prospectively studied cases of first trimester exposure to fluoxetine and no evidence of increased teratogenic risk.3 Postmarketing surveillance study of fluoxetine exposure during pregnancy now includes approximately 1900 cases. Unfortunately, there are no available systematic postmarketing surveillance registers for sertraline.

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