This review focuses on current information about luteal phase administration 
(i.e. typically for the last 2 weeks of the menstrual cycle) of pharmacological 
agents for the treatment of premenstrual dysphoric disorder (PMDD). Compared 
with continuous administration, a luteal phase administration regimen reduces 
the exposure to medication and lowers the costs of treatment. Based on evidence 
from randomised clinical trials, SSRIs are the first-line treatment for PMDD at 
this time. Of these agents, sertraline, fluoxetine and paroxetine (as an 
extended-release formulation) are approved by the US FDA for luteal phase, as 
well as continuous, administration. Clinical trials of these agents and 
citalopram have demonstrated that symptom reduction is similar with both 
administration regimens. When used to treat PMDD, SSRI doses are consistent with 
those used for major depressive disorder. The medications are well tolerated; 
discontinuation symptoms with this intermittent administration regimen have not 
been reported. Other medications that have been examined in clinical trials for 
PMDD or severe premenstrual syndrome (PMS) using luteal phase administration 
include buspirone, alprazolam, tryptophan and progesterone. Buspirone and 
alprazolam show only modest efficacy in PMS (in some but not all studies), but 
there may be a lower incidence of sexual adverse effects with these medications 
than with SSRIs. Symptom reduction with tryptophan was significantly greater 
than with placebo, but the availability of this medication is strictly limited 
because of safety concerns. Progesterone has consistently failed to show 
efficacy for severe PMS/PMDD in large, randomised, placebo-controlled trials.