What medications do you consider in patients with premenstrual dysphoric disorder who do not respond to SSRIs?  

In addition to emphasizing how helpful self-care can be (a little more sleep than usual, exercise, healthy nutrition including limiting carbs, mindfulness), calcium carbonate 600 mg BID, judicious benzodiazepines, and gabapentin 100-300 mg hs can be helpful. Continuous OCPs can also be very useful. ...

Tracking symptoms for several months is important to establish that the problem is indeed premenstrual dysphoric disorder, rather than the periodic exacerbation of a more persistent depressive disorder, borderline personality disorder with mood swings that sometimes coincide with menses, or a form o...