Back to top Open menu arrow
Download Reprints
Sections
GnRHa FOR TREATMENT-RESISTANT PMDD: REVIEW OF THE EVIDENCE PRACTICAL CONSIDERATIONS IN THE USE OF GnRH AGONISTS FOR TREATMENT-RESISTANT PMDD CRITICAL AREAS FOR FUTURE RESEARCH CONCLUSION Clinical Points
The Journal of Clinical Psychiatry The Journal of Clinical Psychiatry

The Journal of
Clinical Psychiatry
Access icon

Systematic Review June 21, 2023

What’s Stopping Us? Using GnRH Analogs With Stable Hormone Addback in Treatment-Resistant Premenstrual Dysphoric Disorder: Practical Guidelines and Risk-Benefit Analysis for Long-term Therapy

Melissa Wagner-Schuman, MD, PhD; Alyssa Kania, MD; Jordan C. Barone, BA; Jaclyn M. Ross, PhD; Ashley Mulvihill, MD; Tory A. Eisenlohr-Moul, PhD

J Clin Psychiatry 2023;84(4):22r14614

ABSTRACT

Objective: Despite the documented success of gonadotropin-releasing hormone analogs (GnRHa) for the treatment of treatment-resistant premenstrual dysphoric disorder (PMDD), many patients struggle to find providers who have sufficient knowledge of PMDD and its evidence-based treatments and/or who are comfortable treating PMDD after first-line treatment options have failed. Here, we discuss the barriers to initiating GnRHa for treatment-resistant premenstrual dysphoric disorder (PMDD) and offer practical solutions to address these barriers for providers who encounter patients with treatment-resistant PMDD but may not have the necessary expertise or comfort with providing evidence-based treatments (ie, gynecologists, general psychiatrists). We have included supplementary materials including patient and provider handouts, screening tools, and treatment algorithms with the hope that this review may serve as a primer on PMDD and the use of GnRHa with hormonal addback as a treatment, as well as a guideline for clinicians delivering this treatment to patients in need.

Options: In addition to offering practical treatment guidelines for first and second lines of treatment for PMDD, this review offers an in-depth discussion of GnRHa for treatment-resistant PMDD.

Outcomes: The burden of illness in PMDD is estimated to be similar to that of other mood disorders, and those suffering from PMDD are at a high risk for suicide.

Evidence: We present a selective review of relevant clinical trials evidence supporting the use of GnRHa with addback hormones in treatment-resistant PMDD (the most recent evidence cited was published in 2021), highlighting the rationale for addback hormones and presenting the different possible hormonal addback approaches.

Values: The PMDD community has and continues to suffer from debilitating symptoms despite the known interventions. This article provides guidance for implementing GnRHa into practice among a broader scope of clinicians including general psychiatrists.

Benefits, Harms, and Costs: The primary benefit of implementing this guideline is that a broad range of clinicians beyond reproductive psychiatrists who encounter patients with PMDD will have a template for assessing and treating PMDD and implementing GnRHa treatment when first-line treatments fail. Harms are expected to be minimal; however, some patients may have side effects or adverse reactions to the treatment or may not respond as they had hoped. Costs of GnRHa can be high depending on insurance coverage. We provide information within the guideline to help navigate this barrier.

Recommendations: (1) Prospective symptom rating in evaluating for PMDD is necessary for diagnosis and evaluating treatment response. (2) SSRIs and oral contraceptives should be trialed as the first- and second-line treatments for PMDD. (3) When first- and second-line treatments have failed to yield symptom relief, the use of GnRHa with hormone addback should be considered. Risks and benefits of GnRHa should be weighed among clinicians and patients, and potential barriers to access should be discussed.

Validation: This article adds to the available systematic reviews on the effectiveness of GnRHa in the treatment of PMDD and Royal College of Obstetrics and Gynecology’s guidelines on the treatment of PMDD.

J Clin Psychiatry 2023;84(4):22r14614

Author affiliations are listed at the end of this article.

 

Continue Reading...

Did you know members enjoy unlimited free PDF downloads as part of their subscription? Subscribe today for instant access to this article and our entire library in your preferred format. Alternatively, you can purchase the PDF of this article individually.

Subscribe Now

Already a member? Login

Purchase PDF for $40

Members enjoy free PDF downloads on all articles. Join today

  1. Pearlstein T, Yonkers KA, Fayyad R, et al. Pretreatment pattern of symptom expression in premenstrual dysphoric disorder. J Affect Disord. 2005;85(3):275–282. PubMed CrossRef
  2. Halbreich U, Borenstein J, Pearlstein T, et al. The prevalence, impairment, impact, and burden of premenstrual dysphoric disorder (PMS/PMDD). Psychoneuroendocrinology. 2003;28(suppl 3):1–23. PubMed CrossRef
  3. Owens SA, Eisenlohr-Moul T. Suicide risk and the menstrual cycle: a review of candidate RDoC mechanisms. Curr Psychiatry Rep. 2018;20(11):106. PubMed CrossRef
  4. Osborn E, Brooks J, O’Brien PMS, et al. Suicidality in women with premenstrual dysphoric disorder: a systematic literature review. Arch Women Ment Health. 2021;24(2):173–184. PubMed CrossRef
  5. Eisenlohr-Moul T, Divine M, Schmalenberger K, et al. Prevalence of lifetime self-injurious thoughts and behaviors in a global sample of 599 patients reporting prospectively confirmed diagnosis with premenstrual dysphoric disorder. BMC Psychiatry. 2022;22(1):199. PubMed CrossRef
  6. Eisenlohr-Moul TA, Girdler SS, Schmalenberger KM, et al. Toward the reliable diagnosis of DSM-5 premenstrual dysphoric disorder: the Carolina Premenstrual Assessment Scoring System (C-PASS). Am J Psychiatry. 2017;174(1):51–59. PubMed CrossRef
  7. Joyce KM, Good KP, Tibbo P, et al. Addictive behaviors across the menstrual cycle: a systematic review. Arch Women Ment Health. 2021;24(4):529–542. PubMed CrossRef
  8. Eisenlohr-Moul TA. Commentary on Joyce et al: studying menstrual cycle effects on behavior requires within-person designs and attention to individual differences in hormone sensitivity. Addiction. 2021;116(10):2759–2760. PubMed CrossRef
  9. Endicott J, Nee J, Harrison W. Daily Record of Severity of Problems (DRSP): reliability and validity. Arch Women Ment Health. 2006;9(1):41–49. PubMed CrossRef
  10. Stone AB, Pearlstein TB, Brown WA. Fluoxetine in the treatment of premenstrual syndrome. Psychopharmacol Bull. 1990;26(3):331–335. PubMed
  11. Stone AB, Pearlstein TB, Brown WA. Fluoxetine in the treatment of late luteal phase dysphoric disorder. J Clin Psychiatry. 1991;52(7):290–293. PubMed
  12. Schmidt PJ, Martinez PE, Nieman LK, et al. Premenstrual dysphoric disorder symptoms following ovarian suppression: triggered by change in ovarian steroid levels but not continuous stable levels. Am J Psychiatry. 2017;174(10):980–989. PubMed CrossRef
  13. Marjoribanks J, Brown J, O’Brien PMS, et al. Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database Syst Rev. 2013;2013(6):CD001396. PubMed CrossRef
  14. Shehata NAA, Moety GAFA, El Wahed HAA, et al. Does adding fluoxetine to combined oral contraceptives containing drospirenone improve the management of severe premenstrual syndrome? a 6-month randomized double-blind placebo-controlled three-arm trial. Reprod Sci. 2020;27(2):743–750. PubMed CrossRef
  15. Freeman EW, Rickels K, Sondheimer SJ, et al. A double-blind trial of oral progesterone, alprazolam, and placebo in treatment of severe premenstrual syndrome. JAMA. 1995;274(1):51–57. PubMed CrossRef
  16. Jackson C, Pearson B, Girdler S, et al. Double-blind, placebo-controlled pilot study of adjunctive quetiapine SR in the treatment of PMS/PMDD. Hum Psychopharmacol. 2015;30(6):425–434. PubMed CrossRef
  17. Landén M, Eriksson O, Sundblad C, et al. Compounds with affinity for serotonergic receptors in the treatment of premenstrual dysphoria: a comparison of buspirone, nefazodone and placebo. Psychopharmacology (Berl). 2001;155(3):292–298. PubMed CrossRef
  18. Halbreich U. Selective serotonin reuptake inhibitors and initial oral contraceptives for the treatment of PMDD: effective but not enough. CNS Spectr. 2008;13(7):566–572. PubMed CrossRef
  19. FDA Drug Safety Communication: Ongoing Safety Review of GnRH Agonists and possible increased risk of diabetes and certain cardiovascular diseases. US Food and Drug Administration. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/fda-drug-safety-communication-ongoing-safety-review-gnrh-agonists-and-possible-increased-risk. Published online June 28, 2019. Accessed November 28, 2022.
  20. Carlini SV, Deligiannidis KM. Evidence-based treatment of premenstrual dysphoric disorder: a concise review. J Clin Psychiatry. 2020;81(2):19ac13071. PubMed CrossRef
  21. Wyatt KM, Dimmock PW, Ismail KMK, et al. The effectiveness of GnRHa with and without “add-back” therapy in treating premenstrual syndrome: a meta analysis. BJOG. 2004;111(6):585–593. PubMed CrossRef
  22. Schmidt PJ, Nieman LK, Danaceau MA, et al. Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome. N Engl J Med. 1998;338(4):209–216. PubMed CrossRef
  23. Pincus SM, Alam S, Rubinow DR, et al. Predicting response to leuprolide of women with premenstrual dysphoric disorder by daily mood rating dynamics. J Psychiatr Res. 2011;45(3):386–394. PubMed CrossRef
  24. Popovic J, Geffner ME, Rogol AD, et al. Gonadotropin-releasing hormone analog therapies for children with central precocious puberty in the United States. Front Pediatr. 2022;10:968485. PubMed CrossRef
  25. Yonkers KA, Simoni MK. Premenstrual disorders. Am J Obstet Gynecol. 2018;218(1):68–74. PubMed CrossRef
  26. Casper RF, Yonkers KA. Treatment of premenstrual syndrome and premenstrual dysphoric disorder. UpToDate. https://www-uptodate-com.proxy.cc.uic.edu/contents/treatment-of-premenstrual-syndrome-and-premenstrual-dysphoric-disorder?search=premenstrual%20dysphoric%20disorder&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H7. Accessed April 4, 2021.
  27. Management of premenstrual syndrome: green-top guideline no. 48. BJOG. 2017;124(3):e73–e105. PubMed CrossRef
  28. Hornstein MD, Surrey ES, Weisberg GW, et al; Lupron Add-Back Study Group. Leuprolide acetate depot and hormonal add-back in endometriosis: a 12-month study. Obstet Gynecol. 1998;91(1):16–24. PubMed CrossRef
  29. Shuster LT, Rhodes DJ, Gostout BS, et al. Premature menopause or early menopause: long-term health consequences. Maturitas. 2010;65(2):161–166. PubMed CrossRef
  30. Melton LJ 3rd, Khosla S, Malkasian GD, et al. Fracture risk after bilateral oophorectomy in elderly women. J Bone Miner Res. 2003;18(5):900–905. PubMed CrossRef
  31. Rivera CM, Grossardt BR, Rhodes DJ, et al. Increased cardiovascular mortality after early bilateral oophorectomy. Menopause. 2009;16(1):15–23. PubMed CrossRef
  32. Rocca WA, Bower JH, Maraganore DM, et al. Increased risk of cognitive impairment or dementia in women who underwent oophorectomy before menopause. Neurology. 2007;69(11):1074–1083. PubMed CrossRef
  33. Vannuccini S, Clemenza S, Rossi M, et al. Hormonal treatments for endometriosis: the endocrine background. Rev Endocr Metab Disord. 2022;23(3):333–355. PubMed CrossRef
  34. Langer RD, Simon JA, Pines A, et al. Menopausal hormone therapy for primary prevention: why the USPSTF is wrong. Menopause. 2017;24(10):1101–1112. PubMed CrossRef
  35. The North American Menopause Society. The NAMS 2017 Hormone Therapy Position Statement Advisory Panel. The 2017 hormone therapy position statement of the North American Menopause Society. Menopause. 2017;24(7):728–753. PubMed CrossRef
  36. Rocca WA, Grossardt BR, de Andrade M, et al. Survival patterns after oophorectomy in premenopausal women: a population-based cohort study. Lancet Oncol. 2006;7(10):821–828. PubMed CrossRef
  37. Bedaiwy MA, Casper RF. Treatment with leuprolide acetate and hormonal add-back for up to 10 years in stage IV endometriosis patients with chronic pelvic pain. Fertil Steril. 2006;86(1):220–222. PubMed CrossRef
  38. Franke HR, van de Weijer PH, Pennings TM, et al. Gonadotropin-releasing hormone agonist plus “add-back” hormone replacement therapy for treatment of endometriosis: a prospective, randomized, placebo-controlled, double-blind trial. Fertil Steril. 2000;74(3):534–539. PubMed CrossRef
  39. Di Carlo C, Palomba S, Tommaselli GA, et al. Use of leuprolide acetate plus tibolone in the treatment of severe premenstrual syndrome. Fertil Steril. 2001;75(2):380–384. PubMed CrossRef
  40. Howell R, Edmonds DK, Dowsett M, et al. Gonadotropin-releasing hormone analogue (goserelin) plus hormone replacement therapy for the treatment of endometriosis: a randomized controlled trial. Fertil Steril. 1995;64(3):474–481. PubMed CrossRef
  41. Surrey ES, Judd HL. Reduction of vasomotor symptoms and bone mineral density loss with combined norethindrone and long-acting gonadotropin-releasing hormone agonist therapy of symptomatic endometriosis: a prospective randomized trial. J Clin Endocrinol Metab. 1992;75(2):558–563. PubMed CrossRef
  42. DiVasta AD, Feldman HA, Sadler Gallagher J, et al. Hormonal add-back therapy for females treated with gonadotropin-releasing hormone agonist for endometriosis: a randomized controlled trial. Obstet Gynecol. 2015;126(3):617–627. PubMed CrossRef
  43. Mitwally MFM, Gotlieb L, Casper RF. Prevention of bone loss and hypoestrogenic symptoms by estrogen and interrupted progestogen add-back in long-term GnRH-agonist down-regulated patients with endometriosis and premenstrual syndrome. Menopause. 2002;9(4):236–241. PubMed CrossRef
  44. Allison MA, Manson JE, Langer RD, et al; Women’s Health Initiative and Women’s Health Initiative Coronary Artery Calcium Study Investigators. Oophorectomy, hormone therapy, and subclinical coronary artery disease in women with hysterectomy: the Women’s Health Initiative Coronary Artery Calcium Study. Menopause. 2008;15(4 Pt 1):639–647. PubMed CrossRef
  45. Ingelsson E, Lundholm C, Johansson ALV, et al. Hysterectomy and risk of cardiovascular disease: a population-based cohort study. Eur Heart J. 2011;32(6):745–750. PubMed CrossRef
  46. Atsma F, Bartelink MLEL, Grobbee DE, et al. Postmenopausal status and early menopause as independent risk factors for cardiovascular disease: a meta-analysis. Menopause. 2006;13(2):265–279. PubMed CrossRef
  47. Salpeter SR, Cheng J, Thabane L, et al. Bayesian meta-analysis of hormone therapy and mortality in younger postmenopausal women. Am J Med. 2009;122(11):1016–1022.e1. PubMed CrossRef
  48. Bove R, Secor E, Chibnik LB, et al. Age at surgical menopause influences cognitive decline and Alzheimer pathology in older women. Neurology. 2014;82(3):222–229. PubMed CrossRef
  49. Rocca WA, Grossardt BR, Shuster LT. Oophorectomy, estrogen, and dementia: a 2014 update. Mol Cell Endocrinol. 2014;389(1–2):7–12. PubMed CrossRef
  50. Kanis JA, Borgstrom F, De Laet C, et al. Assessment of fracture risk. Osteoporos Int. 2005;16(6):581–589. PubMed CrossRef
  51. Committee on Practice Bulletins-Gynecology, The American College of Obstetricians and Gynecologists. Practice Bulletin N 129: osteoporosis. Obstet Gynecol. 2012;120(3):718–734. PubMed CrossRef
  52. Jeremiah MP, Unwin BK, Greenawald MH, et al. Diagnosis and management of osteoporosis. Am Fam Physician. 2015;92(4):261–268. PubMed
  53. Howe TE, Shea B, Dawson LJ, et al. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev. 2011;(7):CD000333. PubMed CrossRef
  54. Jackson RD, LaCroix AZ, Gass M, et al; Women’s Health Initiative Investigators. Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med. 2006;354(7):669–683. PubMed CrossRef
  55. Dawson-Hughes B, Dallal GE, Krall EA, et al. A controlled trial of the effect of calcium supplementation on bone density in postmenopausal women. N Engl J Med. 1990;323(13):878–883. PubMed CrossRef
  56. Reid IR, Ames RW, Evans MC, et al. Effect of calcium supplementation on bone loss in postmenopausal women. N Engl J Med. 1993;328(7):460–464. PubMed CrossRef
  57. Garnick MB, Pratt CM, Campion M, et al. The effect of hormonal therapy for prostate cancer on the electrocardiographic QT interval: phase 3 results following treatment with leuprolide and goserelin, alone or with bicalutamide, and the GnRH antagonist abarelix. J Clin Oncol. 2004;22(suppl):4578. CrossRef
  58. Levine GN, D’Amico AV, Berger P, et al; American Heart Association Council on Clinical Cardiology and Council on Epidemiology and Prevention, the American Cancer Society, and the American Urological Association. Androgen-deprivation therapy in prostate cancer and cardiovascular risk: a science advisory from the American Heart Association, American Cancer Society, and American Urological Association: endorsed by the American Society for Radiation Oncology. CA Cancer J Clin. 2010;60(3):194–201. PubMed CrossRef
  59. Gatti J, Brinker A, Avigan M. Spontaneous reports of seizure in association with leuprolide (Lupron depot), goserelin (Zoladex implant), and naferelin (Synarel nasal spray). Obstet Gynecol. 2013;121(5):1107. PubMed CrossRef
  60. Saylor PJ, Keating NL, Freedland SJ, et al. Gonadotropin-releasing hormone agonists and the risks of type 2 diabetes and cardiovascular disease in men with prostate cancer. Drugs. 2011;71(3):255–261. PubMed CrossRef
  61. Practice Committee of the American Society for Reproductive Medicine. Combined hormonal contraception and the risk of venous thromboembolism: a guideline. Fertil Steril. 2017;107(1):43–51. PubMed CrossRef
  62. Reddy N, Desai MN, Schoenbrunner A, et al. The complex relationship between estrogen and migraines: a scoping review. Syst Rev. 2021;10(1):72. PubMed CrossRef
  63. Zürcher A, Knabben L, Janka H, et al. Influence of the levonorgestrel-releasing intrauterine system on the risk of breast cancer: a systematic review. Arch Gynecol Obstet. 2023;307(6):1747–1761. Published online June 18, 2022. PubMed CrossRef
  64. Poorolajal J, Heidarimoghis F, Karami M, et al. Factors for the primary prevention of breast cancer: a meta-analysis of prospective cohort studies. J Res Health Sci. 2021;21(3):e00520. PubMed CrossRef
  65. Kurebayashi J, Shiba E, Toyama T, et al. A follow-up study of a randomized controlled study evaluating safety and efficacy of leuprorelin acetate every-3-month depot for 2 versus 3 or more years with tamoxifen for 5 years as adjuvant treatment in premenopausal patients with endocrine-responsive breast cancer. Breast Cancer. 2021;28(3):684–697. PubMed CrossRef
  66. Zupi E, Marconi D, Sbracia M, et al. Add-back therapy in the treatment of endometriosis-associated pain. Fertil Steril. 2004;82(5):1303–1308. PubMed CrossRef
  67. Pang SC, Greendale GA, Cedars MI, et al. Long-term effects of transdermal estradiol with and without medroxyprogesterone acetate. Fertil Steril. 1993;59(1):76–82. PubMed CrossRef
  68. Chetkowski RJ, Meldrum DR, Steingold KA, et al. Biologic effects of transdermal estradiol. N Engl J Med. 1986;314(25):1615–1620. PubMed CrossRef
  69. Walsh BW, Schiff I, Rosner B, et al. Effects of postmenopausal estrogen replacement on the concentrations and metabolism of plasma lipoproteins. N Engl J Med. 1991;325(17):1196–1204. PubMed CrossRef
  70. Canonico M, Oger E, Plu-Bureau G, et al; Estrogen and Thromboembolism Risk (ESTHER) Study Group. Hormone therapy and venous thromboembolism among postmenopausal women: impact of the route of estrogen administration and progestogens: the ESTHER study. Circulation. 2007;115(7):840–845. PubMed CrossRef
  71. North American Menopause Society. The 2012 hormone therapy position statement of: the North American Menopause Society. Menopause. 2012;19(3):257–271. PubMed CrossRef
  72. Santen RJ, Allred DC, Ardoin SP, et al; Endocrine Society. Postmenopausal hormone therapy: an Endocrine Society scientific statement. J Clin Endocrinol Metab. 2010;95(suppl 1):s1–s66. PubMed CrossRef
  73. Shifren JL, Schiff I. Role of hormone therapy in the management of menopause. Obstet Gynecol. 2010;115(4):839–855. PubMed CrossRef
  74. Miller VT, LaRosa J, Barnabei V, et al; The Writing Group for the PEPI Trial. Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women. The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial. JAMA. 1995;273(3):199–208. PubMed CrossRef
  75. Gillet JY, Andre G, Faguer B, et al. Induction of amenorrhea during hormone replacement therapy: optimal micronized progesterone dose. A multicenter study. Maturitas. 1994;19(2):103–115. PubMed CrossRef
  76. Hargrove JT, Maxson WS, Wentz AC, et al. Menopausal hormone replacement therapy with continuous daily oral micronized estradiol and progesterone. Obstet Gynecol. 1989;73(4):606–612. PubMed
  77. Moorjani S, Dupont A, Labrie F, et al. Changes in plasma lipoprotein and apolipoprotein composition in relation to oral versus percutaneous administration of estrogen alone or in cyclic association with utrogestan in menopausal women. J Clin Endocrinol Metab. 1991;73(2):373–379. PubMed CrossRef
  78. Wan YL, Holland C. The efficacy of levonorgestrel intrauterine systems for endometrial protection: a systematic review. Climacteric. 2011;14(6):622–632. PubMed CrossRef
  79. Somboonporn W, Panna S, Temtanakitpaisan T, et al. Effects of the levonorgestrel-releasing intrauterine system plus estrogen therapy in perimenopausal and postmenopausal women: systematic review and meta-analysis. Menopause. 2011;18(10):1060–1066. PubMed CrossRef
  80. Fraser IS. Non-contraceptive health benefits of intrauterine hormonal systems. Contraception. 2010;82(5):396–403. PubMed CrossRef
  81. Bednarek PH, Jensen JT. Safety, efficacy and patient acceptability of the contraceptive and non-contraceptive uses of the LNG-IUS. Int J Womens Health. 2010;1:45–58. PubMed CrossRef
  82. Saint Mary’s Hospital Gynecology Services. GnRH Analogue Injections. NHS Manchester University. https://mft.nhs.uk/app/uploads/sites/4/2019/11/19-71-GnRH-analogue-injections-Nov-19.pdf. Published online November 2019.
  83. Maguire K, Joslin-Roher S, Westhoff CL, et al. IUDs at 1 year: predictors of early discontinuation. Contraception. 2015;92(6):575–577. PubMed CrossRef
  84. Van Poppel H, Abrahamsson PA. Considerations for the use of gonadotropin-releasing hormone agonists and antagonists in patients with prostate cancer. Int J Urol. 2020;27(10):830–837. PubMed CrossRef
  85. Dellapasqua S, Gray KP, Munzone E, et al; International Breast Cancer Study Group. Neoadjuvant degarelix versus triptorelin in premenopausal patients who receive letrozole for locally advanced endocrine-responsive breast cancer: a randomized phase II trial. J Clin Oncol. 2019;37(5):386–395. PubMed CrossRef
  86. Lambrinoudaki I, Paschou SA, Lumsden MA, et al. Premature ovarian insufficiency: a toolkit for the primary care physician. Maturitas. 2021;147:53–63. PubMed CrossRef
  87. Comasco E, Kopp Kallner H, Bixo M, et al. Ulipristal acetate for treatment of premenstrual dysphoric disorder: a proof-of-concept randomized controlled trial. Am J Psychiatry. 2021;178(3):256–265. PubMed CrossRef
Purchase PDF for $40

Members enjoy free PDF downloads on all articles. Join today

Save Save

Share Share

Cite Cite

Vol 85 • 2024 • Number 3

Read the Current Issue

Editorial

Focus on Women’s Mental Health: Twenty Years and Counting

Original Research

Esmethadone in Patients With Major Depressive Disorder and Inadequate Response to Standard Antidepressants

Commentary

Can Our Collective Experiences As Clinicians Improve Mental Health Care?

Original Research

Prescription Opioid Use Disorder in US Adults Reporting Prescription Opioid Use

Original Research

Symptomatic Disorders Comorbid with Borderline Personality Disorder Over Time

Original Research

Aripiprazole Lauroxil Initiation Regimens
View current Issue

Celebrating
85 Years

Read the Journal of Clinical Psychiatry

Subscribe to read
more articles

Subscribe