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Postpartum psychosis — USMLE Step 3 MCQ

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HardPsychiatry (Outpatient Management)Postpartum psychosisUSMLE Step 3

A 29-year-old has prospectively confirmed PMDD during three cycles. Symptoms begin predictably 12 days before menses and remit by day 2 of bleeding. She chooses intermittent sertraline rather than continuous medication. Which schedule is evidence based?

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Correct answer: E — Use luteal-phase sertraline and stop shortly after menses begins

The best answer is “Use luteal-phase sertraline and stop shortly after menses begins”. SSRIs can be given continuously or intermittently for PMDD because their therapeutic effect in this disorder is rapid. For a patient selecting intermittent treatment with predictable luteal symptoms, sertraline is started during the luteal phase and stopped at the onset of menses or shortly thereafter. The other schedules omit the symptomatic interval or expose the patient primarily during the follicular phase.

Reference: ACOG Clinical Practice Guideline: Management of Premenstrual Disorders: https://www.acog.org/clinical/clinical-guidance/clinical-practice-guideline/articles/2023/12/management-of-premenstrual-disorders