Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor
Copyright 1998 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.1998
In Reply.— We believe that statements
in our report were accurate. First, several of Dr Cohen's comments relate
to major depressive disorder (MDD), not PMDD. Second, we note that several
small studies and a large multicenter trial1
support the use of other SSRIs, including fluoxetine and paroxetine, for PMDD.
Third, we do not advocate the superiority of one SSRI over another since they
are likely to be of equal efficacy. In the absence of scientific evidence
showing differences in efficacy among SSRIs, drug characteristics are important
to consider in weighing the risks to each patient. A concern in treating women
of childbearing potential is that they may inadvertently conceive during therapy.
Most pregnant women would like to avoid medication use because of the risk,
however large or small, of an adverse affect on the conceptus. Accordingly,
medications with relatively short half-lives are preferable to those with
long half-lives because they can be "washed out" on discontinuation. Fluoxetine
and its metabolite have half-lives of 4 days and between 4 and 16 days, respectively.
Sertraline and paroxetine have half-lives of approximately 24 hours, while
desmethyl sertraline has a half-life between 3 and 5 days.2
Thus, exposure to fluoxetine during pregnancy would be more sustained, even
if a woman stopped taking the medication immediately.
Yonkers KA, Halbreich U, Brown C, Pearlstein T, Freeman E, Endicott J, Severino S, Frank E. Anesthesiology. JAMA. 1998;279(5):357-358. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-5-jbk0204