Menstrual Cycle-Related Depressive Symptoms Treated with Variable Antidepressant Dosage

Cases are reported in which treatment of menstrually related depressive symptoms with varying antidepressant dosage optimized benefit or minimized side effects. Recurrent late luteal phase dysphoria in a 28-year-old woman was only partially relieved by taking 75 mg of nortriptyline daily throughout the menstrual cycle. On 100 mg nortriptyline daily she experienced her greatest symptom relief, but also experienced intolerable side effects during the follicular phase of her cycle. A variable dosing regimen, with the lowest dosage in the week following menses, and highest dosage in the premenstrual week, was well tolerated and provided optimal relief of her premenstrual dysphoric symptoms. Ten additional cases are presented in which catamenial depressive symptoms were optimally treated only with varying antidepressant medication dosage.