There have been a large number of studies conducted investigating the use of 
selective serotonin reuptake inhibitors (SSRIs) in the treatment of patients 
with premenstrual dysphoric disorder (PMDD). The 12 randomised, controlled 
trials with continuous dose administration of SSRIs and the eight randomised, 
controlled trials with luteal phase dose administration (from ovulation to 
menses) are reviewed. All the treatment studies on fluoxetine, sertraline, 
paroxetine and citalopram have reported positive efficacy. Fluoxetine and 
sertraline have the largest literature, with a smaller number of studies 
endorsing paroxetine and citalopram. Mixed efficacy results have been reported 
with fluvoxamine. In general, adverse effects from the use of SSRIs in women 
with PMDD are the usual mild and transient adverse effects from SSRIs including 
anxiety, dizziness, insomnia, sedation, nausea and headache. Sexual dysfunction 
and weight gain can be problematic long-term adverse effects of SSRIs, but these 
effects have not been systematically evaluated with long-term SSRI use in women 
with PMDD. Serotonergic antidepressants have differential superiority over 
nonserotonergic antidepressants in the treatment of PMDD. Treatments that 
enhance serotonergic action improve premenstrual irritability and dysphoria with 
a rapid onset of action, suggesting a different mechanism of action than in the 
treatment of depression. It is possible that neurosteroids, such as progesterone 
metabolites, are involved in the rapid action of serotonergic antidepressants in 
PMDD. Future research needs to address less frequent dose administration 
regimens, such as 'symptom-onset' dose administration, and the recommended 
length of treatment.