--- title: Does taking an antidepressant only during the second half of your cycle reduce anger and aggression in PMDD? description: Yes. Taking escitalopram 20 mg during the second half of the menstrual cycle significantly reduced PMDD symptoms including irritability and anger, and reduced url: https://niyora.com/research/papers/escitalopram-intermittent-use-and-brain-reactivity-to-aggressive-stimuli-in-2025/ --- - [Niyora](https://niyora.com/) - [Research](https://niyora.com/research/) - [Library](https://niyora.com/research/library/) - Does taking an antidepressant only during the second half of your cycle reduce anger and aggression in PMDD? Randomised trial, 2025 # Does taking an antidepressant only during the second half of your cycle reduce anger and aggression in PMDD? Yes. Taking escitalopram 20 mg during the second half of the menstrual cycle significantly reduced PMDD symptoms including irritability and anger, and reduced aggressive responses to provocation. Strong study design 62 women with PMDD ## What they did 62 women with PMDD were randomly assigned to take either escitalopram 20 mg daily or placebo during only the second half (luteal phase) of their menstrual cycle. Researchers measured PMDD symptoms daily and used brain imaging combined with an aggression test where women could respond to provocations. ## What they found Escitalopram significantly reduced PMDD symptoms compared to placebo, especially irritability and anger. Women taking escitalopram also showed less aggression in response to provocations. Brain imaging showed that escitalopram treatment was linked to lower activity in a brain region involved in reacting to threats and anger. ## What it means for you Taking an antidepressant only during the luteal phase (when PMDD symptoms occur) may effectively reduce anger and aggressive responses by changing brain activity. The study was relatively small and used one brain imaging technique, so results might not apply to all women with PMDD. 62 women with PMDD 20 mg daily escitalopram dose ## About the study Original title Escitalopram intermittent use and brain reactivity to aggressive stimuli in premenstrual dysphoric disorder Authors Dubol M, Gröndal M, Schmidt F et al. Journal Research Square Year 2025 Study design Randomised trial Participants 62 What was tested Intermittent escitalopram 20 mg daily during the luteal phase only Open access Yes Read the paper [doi.org/10.21203/rs.3.rs-6224514/v1](https://doi.org/10.21203/rs.3.rs-6224514/v1) Original abstract Abstract Background: Premenstrual dysphoric disorder (PMDD) is a depressive disorder linked to the menstrual cycle, notably characterized by the cyclic occurrence of emotional distress. A core symptom is irritability or anger, whose outcome can be aggressiveness. Intermittent selective serotonin reuptake inhibitor (SSRI) treatment has shown promise in alleviating symptoms, yet the neural underpinnings of its rapid efficacy remain unknown. This randomized controlled trial aimed to evaluate the impact of intermittent SSRI treatment for PMDD on aggression-related brain function. Methods: Women with PMDD (n = 62) were randomized to receive either intermittent escitalopram (20mg/day) or placebo during the luteal phase of the menstrual cycle. Symptoms were assessed using the Daily Record of Severity of Problems. Functional magnetic resonance imaging (fMRI) was conducted in combination with the Point Subtraction Aggression Paradigm (PSAP) to evaluate neural responses to aggression-related stimuli. Results: Intermittent escitalopram treatment significantly reduced PMDD symptoms compared to placebo, particularly irritability or anger. Aggressiveness, that was positively associated with these key symptoms, diminished as an effect of treatment, with irritability mediating the relationship between treatment and aggressiveness. Reactivity to provocations was associated with lower activation of the anterior insula upon treatment with escitalopram, which also positively related to irritability. Conclusions: These findings suggest a potential neural mechanism underlying the therapeutic effects of SSRIs in PMDD and provide insights into their role, in an interplay with gonadal hormones, in modulating reactive aggression. Reproduced under CC-BY. ## Topics [Premenstrual dysphoric disorder (PMDD)](https://niyora.com/research/topics/condition-pmdd/)[Menstrual cycle and mood](https://niyora.com/research/topics/condition-cycle-mood/)[Low mood and depression](https://niyora.com/research/topics/symptom-depression-mood/)[Irritability and anger](https://niyora.com/research/topics/symptom-irritability-anger/)[SSRIs and antidepressants](https://niyora.com/research/topics/treatment-ssri/)[Major depressive disorder](https://niyora.com/research/topics/comorbidity-major-depression/) Research tells you what helps on average. Niyora helps on the day it hits. Calm down, see it another way, and decide what to say, with a PMS and PMDD app built by a doctor. ## Related studies Cohort study, 2022 What are PMS and PMDD and how should they be diagnosed and treated? Cohort study, 2012 How quickly does fluoxetine start working for PMDD symptoms? Case-control study, 2007 Are there genes that increase the risk of PMDD? Review, 1999 Is premenstrual dysphoric disorder a distinct clinical disorder? Case report, 2022 Does sertraline help women with severe premenstrual dysphoric disorder? Survey study, 2001 How common is premenstrual dysphoric disorder and how is it related to other psychiatric conditions? Ask AI about this page Copy prompt ChatGPT ↗ Claude ↗ Perplexity ↗ Google AI Mode ↗ Grok ↗