10 Off-label Uses of Antidepressants

Relieving Symptoms of PMDD
It’s estimated that 3 to 8 percent of women have premenstrual dysphoric disorder. © LuckyBusiness/iStockphoto

As many as 85 percent of menstruating women report they experience at least one symptom of premenstrual syndrome (PMS), with bloating, headaches, backaches, breast tenderness and mood swings as some of the more common complaints [source: Barclift]. But about 3 to 8 percent of women have premenstrual dysphoric disorder (PMDD), a severe form of PMS marked by intense depression, anxiety or irritability, and mood swings. In 2013 PMDD was officially added to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) as a mood disorder [source: Novosolov].

Serotonin, GABA and β-endorphin are the three primary neurotransmitters indicated in PMDD, and selective serotonin reuptake inhibitors (SSRIs) are considered effective treatment for the disorder. Seventy-five percent of women suffering from PMDD report a decrease in symptoms while taking a SSRI [sources: Stöppler, Pattimakiel]. SSRIs, it turns out, do more than just interact with serotonin receptors: They also change how the body converts progesterone to a hormone called allopregnanolone. Allopregnanolone is a naturally occurring neurosteroid that acts like a sedative and mood stabilizer.

Antidepressants effectively reduce mood-related symptoms for women diagnosed with PMDD, and, although not FDA approved to treat PMS, SSRIs may reduce symptoms such as mood swings and irritability in some women who experience PMS. As many as 40 percent of women who report symptoms of PMS, though, don't report relief from SSRIs, nor do SSRIs appear to relieve physical symptoms of PMS [source: Barclift].

And it's not just the symptoms of PMS that women are treating with SSRIs. Popular antidepressants such as escitalopram (Lexapro) are prescribed off-label to lessen hot flashes in menopausal women; paroxetine (Paxil) is the one antidepressant approved as a non-hormonal treatment for hot flashes, marketed as Brisdelle.