Short-Term Versus Long-Term Treatment for Severe Premenstrual Syndrome (PMS)

Short-Term Versus Long-Term Treatment for Severe PMS

Serotonergic antidepressants are clearly effective for premenstrual syndrome (PMS). This study compares short-term treatment (4 months) and long-term treatment (12 months) with sertraline to determine how long medication should be continued after achieving a good response, how soon symptoms return after stopping medication, and whether symptoms are further improved with long-term treatment. Multiple hypotheses include the following: The percent of relapsed subjects is greater with short-term treatment; relapse is swifter with short-term treatment; relapsed subjects improve swiftly when returned to medication; patient satisfactions and quality of life are more improved with long-term treatment.

Study Overview

• Status: Completed
• Conditions: Premenstrual Syndrome
• Intervention / Treatment: Drug: sertraline

Detailed Description

Severe PMS is a chronic and complex mood disorder that involves mood, behavioral and physical symptoms linked to the menstrual cycle with severity that disrupts functioning for as much as several weeks each menstrual cycle. Estimates indicate that 20-25% of menstruating women experience severe PMS. The efficacy of serotonergic antidepressants is clearly demonstrated for severe forms of PMS in short-term treatment trials. This study compares short-term treatment (4 months) and long-term treatment (12 months) with sertraline in a randomized, placebo-controlled design. The purpose is to determine how long medication should be continued following symptom relief, to what extent and how rapidly symptoms return after stopping medication, and whether there is any additional improvement with long-term treatment.

Following a screen period for 2-3 menstrual cycles that includes a placebo-treated cycle, eligible women are randomized double-blind to the short-term or long-term treatment arm. Subjects are switched (double-blind) to placebo after 4 months or 12 months of sertraline treatment. All subjects continue the study for a total of 21 months and receive either sertraline or the matching placebo in this interval. Subjects whose symptoms return are given open-label sertraline without breaking the study blind. Subjects rate symptoms daily throughout the study using the Penn Daily Symptom Report. Other assessments are conducted at monthly intervals and include the Clinical Global Impressions Rating Scale, Sheehan Disability Scale, Hamilton Depression Rating Scale, Endicott Quality of Life Questionnaire and the Cohen Perceived Stress Scale. The overall duration of the study is expected to be 5-6 years.

• Study Type: Interventional
• Enrollment (Actual): 174
• Phase: Phase 4

Contacts and Locations

Study Locations

• United States
  • Pennsylvania
    • Philadelphia, Pennsylvania, United States, 19104
      • Department of Obstetrics/Gynecology, University of Pennsylvania, School of Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 45 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

• Women with PMS for at least 1 year.
• Ages 18-45 years
• Regular menstrual cycles in normal range (22-36 days) for at least 6 months
• In general good health as determined by physical examination and blood tests.
• Evidence of ovulation using a urine test.
• Meeting stated criteria for PMS.
• Signed informed consent.

Exclusion Criteria:

• Any prescription, over-the-counter, herbal or non-medical therapies for PMS.
• Use of psychotropic medications that cannot be stopped for the duration of the study.
• Other current psychiatric diagnoses as determined by SCID interview.
• Alcohol or substance abuse/dependence or suicide attempt within the past 12 months; lifetime history of psychosis, bipolar disorder and clearly identifiable severe personality disorder.
• Hysterectomy, symptomatic endometriosis, irregular menstrual cycles,any severe or unstable medical illness.
• Lack of medically-approved contraception, currently pregnant, intention to become pregnant or breast feeding.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Penn Daily Symptom Report (DSR)	daily

Secondary Outcome Measures

Outcome Measure	Time Frame
Hamilton Depression Scale	monthly
Quality of Life Questionnaire	monthly
Sheehan Disability Scales	monthly
Clinical Global Rating of Severity and Improvement	monthly

Collaborators and Investigators

• Sponsor: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
• Investigators: Principal Investigator: Ellen W Freeman, PhD, University of Pennsylvania, School of Medicine, Department of Ob/Gyn; Principal Investigator: Steven J Sondheimer, MD, University of Pennsylvania; Principal Investigator: Karl Rickels, MD, University of Pennsylvania

Publications and helpful links

General Publications

• Freeman EW, Rickels K, Sammel MD, Lin H, Sondheimer SJ. Time to relapse after short- or long-term treatment of severe premenstrual syndrome with sertraline. Arch Gen Psychiatry. 2009 May;66(5):537-44. doi: 10.1001/archgenpsychiatry.2008.547.

Study record dates

Study Major Dates

• Study Start: February 1, 2002
• Primary Completion (Actual): December 1, 2007
• Study Completion (Actual): February 1, 2008

Study Registration Dates

• First Submitted: April 25, 2006
• First Submitted That Met QC Criteria: April 25, 2006
• First Posted (Estimate): April 27, 2006

Study Record Updates

• Last Update Posted (Estimate): February 27, 2009
• Last Update Submitted That Met QC Criteria: February 26, 2009
• Last Verified: April 1, 2006

More Information

Terms related to this study

• Keywords: relapse; sertraline; PMS; antidepressant; PMDD; extended treatment
• Additional Relevant MeSH Terms: Pathologic Processes; Disease; Menstruation Disturbances; Syndrome; Premenstrual Syndrome; Physiological Effects of Drugs; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action; Psychotropic Drugs; Serotonin Uptake Inhibitors; Neurotransmitter Uptake Inhibitors; Membrane Transport Modulators; Serotonin Agents; Antidepressive Agents; Sertraline
• Other Study ID Numbers: R01HD018633 (U.S. NIH Grant/Contract)