At a glance
- Alprazolam (Xanax) is the only benzodiazepine tested in PMDD trials; Ativan and Klonopin haven't been studied for it directly.
- Results are mixed: several older trials found alprazolam eased tension and anxiety, but a tightly controlled 1993 NIMH trial found no real benefit.
- It seemed to help only women whose symptoms were limited to the luteal phase, not those who also had anxiety or low mood earlier in the cycle.
- In the trials, it was dosed only from mid-cycle through the first days of a period, then tapered down to limit withdrawal.
- Guidelines place SSRIs and certain hormonal options ahead of benzodiazepines, since the evidence is stronger and dependency risk is lower.
Strength of evidence
Mixed evidence
Alprazolam (Xanax) is the only benzodiazepine with controlled trials in PMDD. Several older placebo-controlled studies found it eased luteal-phase symptoms, but a well-designed 1993 trial and a 1998 lab study found no real mood benefit. No trials exist for other benzodiazepines in PMDD.
Does Xanax help with PMDD?
Xanax (alprazolam) has more research behind it than any other benzodiazepine for PMDD, and the results disagree with each other.
Several placebo-controlled trials from the late 1980s and early 1990s found that alprazolam, taken only in the days before a period, eased tension, irritability, anxiety, and low mood more than placebo [1] [4] [5]. One crossover trial found the benefit held for women whose symptoms were limited to the week before their period, but not for women who also had mild anxiety or low mood earlier in the cycle [3].
A more rigorously controlled trial at the National Institute of Mental Health found no real difference between alprazolam and placebo on almost every measure [6]. A separate lab study testing single acute doses found alprazolam didn't improve premenstrual mood at all, and made mood worse during the follicular phase [2].
Alprazolam helps some women with PMDD, but the trials don't agree, and it's far less studied than SSRIs. Read more about PMDD and how it's diagnosed.
What does the research say?
Here's how the main controlled trials compare.
| Trial | What it tested | What it found |
|---|---|---|
| 1987, Obstetrics and Gynecology [5] | Alprazolam 0.25 mg three times daily, cycle day 20 to day 2, then tapered | Better than placebo for irritability, anxiety, mood swings, cramps, and more |
| 1990, Archives of General Psychiatry, 30 women [1] | Crossover design with a placebo washout period | Alprazolam better than placebo on both daily and physician ratings |
| 1994, Obstetrics and Gynecology, two groups [3] | Alprazolam 0.25 mg three times daily | Helped women with PMDD alone; no benefit for women who also had anxiety or low mood earlier in the cycle |
| 1995, JAMA, 170 women [4] | Alprazolam vs. oral progesterone vs. placebo | Alprazolam outperformed both; about 37% had symptoms cut in half |
| 1993, Archives of General Psychiatry, 22 women [6] | Doses up to 0.75 mg three times daily over four cycles | No real difference from placebo except on one depression scale |
| 1998, Neuropsychopharmacology, lab study [2] | Single acute doses, tested in both cycle phases | No improvement in premenstrual mood; mood worsened in the follicular phase |
Four trials found a benefit, two didn't, and the negative trials used more careful designs in some ways. That makes the overall picture mixed rather than clearly positive. See how this compares with other treatments on our PMS and PMDD research page.
How do you take benzodiazepines for PMDD?
In the trials that found a benefit, alprazolam was dosed only during the days symptoms show up, not all month.
The trials tracked cycles with daily symptom diaries to find when symptoms start [1] [4] [5] [6]. Alprazolam was started only in the days before a period and tapered off afterward rather than stopped all at once, to limit withdrawal [4] [7]. The exact schedule, and whether this approach is right for you, is something a doctor decides.
Trial doses varied, and a doctor sets the right one for you. A doctor decides your exact dose and schedule, since it depends on your cycle length, other medications, and health history.
How long does it take to work?
Benzodiazepines act directly on the brain's GABA receptors, so they tend to work faster than SSRIs, often within the first week of use for anxiety in general [7].
In the PMDD trials, researchers tracked results over multiple luteal-phase cycles, often three to four, since that's how long it takes to see whether a pattern holds [4] [5]. One crossover trial saw a benefit after as little as one treated cycle [1]. Within a single treated cycle, women in the positive trials usually reported less tension and irritability during the days they were taking it, not weeks later.
That's different from SSRIs, which can take a cycle or more to show their full effect even when taken every day. If you're using alprazolam cyclically, you and your doctor will usually know within one or two treated cycles whether it's helping enough to keep using.
What are the side effects?
Alprazolam's side effects in the PMDD trials matched what's known about benzodiazepines generally.
Common effects to know about:
- Drowsiness and sedation, especially early in treatment [7] [8]
- Slower reaction time and impaired coordination, which matters for driving [2] [7]
- Memory and performance effects on tasks that need focus [2] [7]
- Dependency and withdrawal symptoms with regular use, which is why tapering matters [7]
Side effects were dose-related in at least one trial: lower doses caused fewer problems, and higher doses caused more, both in how often they happened and how severe they were [3].
Most of these effects ease once the dose is tapered down after the luteal phase ends, which is part of why researchers limited dosing to that window in the first place.
Who should avoid it?
Benzodiazepines aren't right for everyone with PMDD.
Avoid or be cautious with alprazolam if:
- You have a personal or family history of substance use problems, given the dependency risk [7]
- You're pregnant or trying to become pregnant
- Your job or daily life involves driving or operating machinery that needs quick reaction time [2] [7]
- You also have anxiety or low mood outside the luteal phase, since trials found alprazolam didn't help this group as much [3]
A PMDD specialist can help you weigh benzodiazepines against other options and watch for withdrawal if you stop.
What else helps alongside it?
Benzodiazepines are rarely the first option guidelines recommend for PMDD.
Other approaches with more consistent evidence:
- SSRIs, taken daily or only in the luteal phase, which guidelines list as first-line (see our guide to PMDD treatment)
- Certain hormonal contraceptives
- Cognitive behavioral therapy
- Tracking your cycle so you and your doctor can see the pattern clearly
Niyora is a PMS and PMDD support app. Its Moon tool lets you write down what happened in a hard moment, see it from another angle, calm down, and draft a reply you can hold onto for 20 minutes before you send it. It won't replace a prescription, but it can help on the nights before one starts working.
If you're wondering whether benzodiazepines help with PMS rather than PMDD specifically, we've covered benzodiazepines for PMS separately.
Questions people ask
Does Xanax help with PMDD rage?+
Xanax (alprazolam) eased irritability and anger in several older placebo-controlled trials, but a more rigorous 1993 trial found no real benefit over placebo. The evidence for PMDD rage is mixed, and alprazolam seemed to help only women whose symptoms were limited to the week before their period.
Is Ativan or Klonopin studied for PMDD?+
No controlled trials have tested lorazepam (Ativan) or clonazepam (Klonopin) for PMDD specifically. Nearly all the research on benzodiazepines for PMDD looks at alprazolam (Xanax), so there's no direct evidence that other benzodiazepines work the same way for premenstrual symptoms.
Can you take Xanax only before your period?+
Several PMDD trials dosed alprazolam only from the start of the luteal phase through the first days of a period, then tapered it down. This cyclic approach was meant to lower the risk of dependency and withdrawal compared with taking it every day of the month.
Why do doctors usually recommend SSRIs over benzodiazepines for PMDD?+
SSRIs have more consistent trial evidence for PMDD and carry a lower risk of dependency than benzodiazepines like alprazolam. Guidelines list SSRIs and some hormonal contraceptives as first-line options, keeping benzodiazepines as a second choice when other treatments haven't worked or aren't tolerated.
Is alprazolam addictive when used for PMDD?+
Alprazolam can cause dependency and withdrawal symptoms with regular use, though one large trial found no significant withdrawal problems when it was limited strictly to the luteal phase and tapered afterward. Stopping it abruptly, especially with daily use, is the main risk to watch for.
Sources
- 1.Treatment of premenstrual dysphoria with alprazolam. A controlled study, Archives of general psychiatry, 1990
- 2.Mood and performance changes in women with premenstrual dysphoric disorder: acute effects of alprazolam, Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 1998
- 3.Alprazolam in the treatment of two subsamples of patients with late luteal phase dysphoric disorder: a double-blind, placebo-controlled crossover study, Obstetrics and gynecology, 1994
- 4.A double-blind trial of oral progesterone, alprazolam, and placebo in treatment of severe premenstrual syndrome, JAMA, 1995
- 5.Treatment of premenstrual syndrome with alprazolam: results of a double-blind, placebo-controlled, randomized crossover clinical trial, Obstetrics and gynecology, 1987
- 6.Alprazolam in the treatment of premenstrual syndrome. A double-blind, placebo-controlled trial, Archives of general psychiatry, 1993
- 7.Clinical pharmacology, clinical efficacy, and behavioral toxicity of alprazolam: a review of the literature, CNS drug reviews, 2004
- 8.The pharmacology of alprazolam: a review, Clinical therapeutics, 1991