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Reduction of alcohol may reduce irritability and decrease serotonergic inhibition. The American College of Obstetricians and Gynecologists recommends magnesium, vitamin E, and calcium as nutritional supplements to help with premenstrual symptoms (8). A meta- a nalysis of nine trials evaluated the efficacy of vitamin B 6 ; this study showed that dosages up to 100 mg/d are likely to help with luteal phase emotional and physical symptoms (9). Calcium supplementation has also been ex a mined, and dosages of 1000 to 1200 mg/d of elemental calcium have been shown to be effective in symptom reduction.

Initially, there was thought to be an imbalance in estrogen- t o- p rogesterone ratios; however, current consensus favors normal hormonal function. Current theory suggests that the normal variation in ovarian hormones and their interaction with central neurotransmitters is the inciting factor in PMDD (4). The normal cyclic variation in estrogen and progesterone during a regular menstrual cycle has been shown to cause changes in the y- a mino butyric acid (GABA), serotonin, and opioid responses of the central nervous system.

Although these side effects are more common at higher dosages, luteal phase dosing may help to minimize these undesired side effects in women who derive Chapter 2 / Premenstrual Syndrome and Premenstrual Dysphoric Disorder 25 emotional and other physical benefits from an SSRI. An attractive luteal phase dosing option is 90 mg fluox e tine administered once weekly for 2 weeks, which showed efficacy in a recent study (17). Non- S SRI Antidepressants Other non- S SRI antidepressants have been evaluated for PMDD.

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