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According to several double-blind studies, sertraline is effective in alleviating the symptoms of PMDD, a severe form of premenstrual syndrome. Significant improvement was observed in 50-60% of sertraline patients vs 20-30% of placebo patients. The improvement began during the first week of treatment, and in addition to mood, irritability, and anxiety it was reflected in better family functioning, social activity and general quality of life. Work functioning and the physical symptoms, such as swelling, bloating and breast tenderness, were less responsive to sertraline.[49][50][51] In spite of the well-known sexual side effects of sertraline, significantly higher improvement of sexual functioning was achieved by the sertraline group as compared to the placebo group.[52] A three-way comparison of sertraline, norepinephrine reuptake inhibitor tricyclic antidepressant desipramine, and placebo demonstrated the superiority of sertraline, while desipramine fared no better than placebo.[53] Taking sertraline during the luteal phase, that is only for 12–14 days before menses, was shown to work as well as the continuous treatment.[54][55][52] Although the luteal phase treatment may be more acceptable to patients, there have been indications that by the end of a three-month period it is less well tolerated than the continuous treatment. The study authors suggested that the continuous treatment may allow the tolerance to side effects of sertraline to develop faster.[52] The most recent 2006 trial findings indicate that the continuous treatment with sub-therapeutic dose of sertraline (25 mg vs usual 50-100 mg) may both afford the best efficacy and minimize the side effects.[56]
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