A study of women suffering from severe premenstrual irritability and anger found that escitalopram reduced their irritability and anger in the luteal phase of the menstrual cycle. Participants on escitalopram also demonstrated a lower frequency of anticipatory responses and greater consistency in response speeds in a sustained attention test. The paper was published in Psychological Medicine.
The menstrual cycle is a recurring biological process in which hormonal changes prepare the body of a woman for a possible pregnancy. It is commonly divided into the menstrual, follicular, ovulatory, and luteal phases. The cycle begins with menstruation, when the uterine lining is shed and menstrual bleeding occurs. Ovulation occurs around the middle of the cycle, when a mature egg is released from the ovary. The last is the luteal phase, during which progesterone becomes dominant and the uterine lining is maintained in preparation for a possible pregnancy. If pregnancy does not occur, estrogen and progesterone levels fall toward the end of the luteal phase, leading to the beginning of a new menstrual cycle.
For some women, these hormonal changes are accompanied by recurring emotional, behavioral, and physical symptoms that become particularly pronounced before menstruation. These changes, called premenstrual symptoms, are thought to be linked to normal fluctuations in sex hormones across the menstrual cycle. In more severe cases, the symptoms may form part of premenstrual dysphoric disorder, or PMDD. In this disorder, several symptoms repeatedly emerge during the luteal phase and largely disappear after menstruation begins.
Studies have shown that selective serotonin reuptake inhibitors, or SSRIs, a type of medication used to treat depression, can be effective in reducing the symptoms of PMDD within only a few days. This suggests that serotonin, a neurotransmitter affected by SSRIs, might play an important role in premenstrual symptoms. It seems to be particularly effective in reducing irritability, anger, and rapid mood shifts.
Study author Maria Gröndal and her colleagues conducted a study in which they examined possible cognitive components of impulsivity in premenstrual irritability. They also examined the women’s sustained attention and the effects of intermittent treatment with escitalopram, a widely used SSRI.
Study participants were 27 women suffering from severe premenstrual irritability and anger, selected from an initial pool of 203 prospective participants. Participants were included in the study if they showed at least a 50% increase in irritability/anger symptoms from the follicular phase to the luteal phase of a menstrual cycle, and had a mean rating of irritability/anger over a threshold study authors defined over the last 5 days of the menstrual cycle. Participants’ average age was 33 years. 85% of them had a university degree. Participants received 1000 SEK (around $100) for each of their three lab visits, plus reimbursement for travel or loss of income.
The study extended over three of the study participants’ menstrual cycles. The first cycle did not involve any intervention. In cycles 2 and 3, participants were randomly assigned to either receive 20mg of escitalopram per day during the luteal phase of cycle 2 and placebo (an identically looking pill with no effects) during the luteal phase of cycle 3, in a single-blind design, or to receive these same treatments in the reverse order (placebo in cycle 2, escitalopram in cycle 3).
Participants completed a sustained attention test (the Conners Continuous Performance Test 3 – CPT 3) twice, once in the luteal phase of cycle 2 and once in the luteal phase of cycle 3. They also completed an assessment of impulsivity twice – once in the follicular phase and once in the luteal phase of the cycle when they were receiving placebo. Participants also rated their symptoms on a daily basis using an online survey. The symptoms they rated were irritability/anger, depressed mood, mood swings, and tension/anxiety.
Results showed that participants reported significantly higher levels of negative urgency (the tendency to act impulsively when experiencing negative emotions) during the luteal phase of the menstrual cycle compared to the follicular phase. They also showed lower levels of sensation seeking. There were no differences between phases of the menstrual cycle in the other two aspects of impulsivity (lack of premeditation and lack of perseverance).
On the sustained attention test, perseverations (anticipatory, repetitive, or random responses) were significantly higher during the placebo cycle than during the escitalopram cycle. During the menstrual cycle when participants were receiving placebo, they also showed greater variability in their response speeds. In other words, escitalopram reduced participants’ anticipatory responses and made their reaction speeds more consistent. Escitalopram treatment also caused a significant reduction in self-rated irritability, anger, and mood swings in the luteal phase.
“The current study showed that intermittent treatment with escitalopram during the symptomatic luteal phase of the menstrual cycle may have a beneficial impact on specific aspects of impulsivity and inattentiveness in women with severe premenstrual irritability and anger. Moreover, our findings showed that self-reported urgency increased, whereas self-reported sensation seeking decreased in the luteal versus the follicular phase, suggesting that different facets of impulsivity may be of different significance to premenstrual complaints,” study authors concluded.
The study contributes to the scientific knowledge about premenstrual disorders and ways to treat their symptoms. However, it should be noted that the study was conducted on a very small group of women, selected for severe premenstrual irritability and anger. Results of studies involving larger groups of women may not be identical.
The paper, “The effects of intermittent escitalopram treatment on impulsivity and inattention in women with premenstrual irritability and anger,” was authored by Maria Gröndal, Christin Englund, Jakob Näslund, Karl Ask, Elias Eriksson, and Stefan Winblad.