What is the first-line treatment for PMDD mood and behavioral symptoms?

• A. Antidepressants (unspecified)
• B. Antipsychotics
• C. Beta blockers
• D. Selective serotonin reuptake inhibitors (SSRIs)

Answer: (D)

The main idea is that mood and behavioral symptoms in PMDD respond best to boosting serotonin with an SSRI. SSRIs have the most consistent, strong evidence for reducing irritability, mood swings, depression, and anxiety that occur during the luteal phase, and they can be used either continuously or only in the luteal phase to target cyclical symptoms. They often produce relief relatively quickly, sometimes within days of starting or adjusting the dosing, which makes them especially effective for this condition. Examples include fluoxetine, sertraline, paroxetine, and fluvoxamine.

Other options don’t target the core mood symptoms in the same proven way: beta blockers help physical symptoms like rapid heartbeat or tremor but don’t address mood changes; antipsychotics are not indicated for PMDD mood/behavioral symptoms; treating with antidepressants without specifying an SSRI misses the most studied and tolerated class for this disorder.