Title

Comparison of Fluoxetine, Calcium and Placebo for the Treatment of Moderate to Severe Premenstrual Syndrome (PMS)
A Double-blind, Parallel Comparison of Fluoxetine, Calcium and Placebo for the Treatment of Moderate to Severe Premenstrual Syndrome (PMS)
  • Phase

    N/A
  • Study Type

    Interventional
  • Study Participants

    49
The purpose of this study is to compare the efficacy of calcium carbonate to fluoxetine in the treatment of moderate to severe PMS. Second, to compare each active agent to a placebo control. Third, to evaluate the efficacy of each treatment for specific symptom clusters (i.e. affective and somatic). Fourth, to determine whether the addition of calcium to on going fluoxetine treatment leads to additional therapeutic benefit.
This is a double blind, randomized, placebo controlled, parallel study that will randomize 60 women at the Yale site into treatment. Participants will be screened at various collaborating ob-gyn centers for possible PMS symptoms, and direct referrals from the community will also be accepted. Subject participation length is about 7 months with 6 scheduled study visits.

Methodology: After successfully completing the screening and qualification phase, participants will be randomized to treatment at Visit 1 for 5 cycles of double-blind treatment. Participants will be evaluated monthly during the randomization phase for adverse events, concurrent medication, and primary and secondary efficacy variables.

.
Study Started
Sep 30
2000
Primary Completion
Jun 30
2010
Study Completion
Oct 31
2010
Results Posted
Feb 26
2015
Estimate
Last Update
Mar 23
2015
Estimate

Drug Fluoxetine

Fluoxetine 20 mg per day for 4 menstrual cycles. For the fifth menstrual cycle, all women will receive calcium. Women on Fluoxetine will continue taking it in addition to 1200mg of calcium.

  • Other names: Prozac

Drug Calcium

1200 mg of calcium to be taken for 5 menstrual cycles.

Drug Placebo

For 5 cycles, women will receive placebo. At the end of the fourth cycle, all women will receive 1200 mg of calcium in addition to the placebo medication.

I Active Comparator

Fluoxetine

II Active Comparator

Calcium

III Placebo Comparator

Criteria

Inclusion Criteria:

Female outpatients between the ages of 18 and 48 who are:

Menstruating
Meet criteria for moderate to severe PMS
Report PMS symptoms for at least 9 our of the 12 months prior to screening; 4) *Are using an adequate method of birth control.

Exclusion Criteria:

Any candidate who:

Fulfills MINI (DSM-IV) criteria for a serious AXIS 1 disorder
Fulfills DSM-IV criteria during the charting phase consistent with a diagnosis of psychotic disorder, bipolar disorder or major depressive disorder
Has a severe, co-existing condition that, in the investigator's opinion, renders the patient unsuitable for the study
Poses a significant risk of suicide
Takes ongoing medication that could treat PMS symptoms
Has a history of hypersensitivity or adverse reaction to fluoxetine or calcium
Is lactating, pregnant or is planning to become pregnant during the course of the study.

Summary

I: Fluoxetine

II: Calcium

III: Placebo

All Events

Event Type Organ System Event Term I: Fluoxetine II: Calcium III: Placebo

Comparison of the Change in IDS Symptom Scores Among Groups

IDS = Inventory of Depressive Symptomatology: measures depressive symptoms during the previous premenstrual phase with high internal consistency: sum of responses to 28 of 30 possible items each scored 0 to 3 points with total scoring (0=no symptoms, 84=most severe). This outcome is a measure of effect size between the two trial groups and the placebo group, with the placebo effect size value used as a reference.

I: Fluoxetine

Visit 1

31.85
units on IDS scale (Mean)
Standard Deviation: 9.14

Visit 2

14.08
units on IDS scale (Mean)
Standard Deviation: 9.53

Visit 3

11.44
units on IDS scale (Mean)
Standard Deviation: 7.94

Visit 4

11.78
units on IDS scale (Mean)
Standard Deviation: 8.50

Visit 5

10.0
units on IDS scale (Mean)
Standard Deviation: 6.41

II: Calcium

Visit 1

30.92
units on IDS scale (Mean)
Standard Deviation: 7.62

Visit 2

25.77
units on IDS scale (Mean)
Standard Deviation: 7.74

Visit 3

18.55
units on IDS scale (Mean)
Standard Deviation: 10.40

Visit 4

18.5
units on IDS scale (Mean)
Standard Deviation: 9.01

Visit 5

19.55
units on IDS scale (Mean)
Standard Deviation: 9.04

III: Placebo

Visit 1

28.85
units on IDS scale (Mean)
Standard Deviation: 9.97

Visit 2

20.69
units on IDS scale (Mean)
Standard Deviation: 12.20

Visit 3

20.15
units on IDS scale (Mean)
Standard Deviation: 14.25

Visit 4

16.46
units on IDS scale (Mean)
Standard Deviation: 11.00

Visit 5

18.08
units on IDS scale (Mean)
Standard Deviation: 9.17

Comparison of the Change in PMTS Symptom Scores Among Groups

PMTS = Premenstrual Tension Syndrome (Observer Rating) Scale: a clinician-administered retrospective scale developed for the study of PMS, a sum of responses to 10 items each with 4 points (0=no symptoms, 40=most severe). This outcome is a measure of effect size between the two trial groups and the placebo group, with the placebo effect size value used as a reference.

I: Fluoxetine

Visit 1

24.15
units on PMTS scale (Mean)
Standard Deviation: 5.40

Visit 2

11.15
units on PMTS scale (Mean)
Standard Deviation: 5.77

Visit 3

10.33
units on PMTS scale (Mean)
Standard Deviation: 6.40

Visit 4

12.11
units on PMTS scale (Mean)
Standard Deviation: 7.13

Visit 5

10.13
units on PMTS scale (Mean)
Standard Deviation: 3.56

II: Calcium

Visit 1

21.58
units on PMTS scale (Mean)
Standard Deviation: 3.73

Visit 2

18.54
units on PMTS scale (Mean)
Standard Deviation: 5.36

Visit 3

13.36
units on PMTS scale (Mean)
Standard Deviation: 5.75

Visit 4

12.83
units on PMTS scale (Mean)
Standard Deviation: 4.73

Visit 5

11.91
units on PMTS scale (Mean)
Standard Deviation: 4.48

III: Placebo

Visit 1

20.85
units on PMTS scale (Mean)
Standard Deviation: 6.62

Visit 2

16.0
units on PMTS scale (Mean)
Standard Deviation: 8.15

Visit 3

16.38
units on PMTS scale (Mean)
Standard Deviation: 10.52

Visit 4

12.77
units on PMTS scale (Mean)
Standard Deviation: 8.21

Visit 5

14.58
units on PMTS scale (Mean)
Standard Deviation: 7.58

Comparison of the Change in CGI-S Symptom Scores Among Groups

CGI-S = Clinical Global Impression-Severity: a severity scale widely used in psychopharmacology research (1=normal not at all ill, 7=among most extremely ill). This outcome is a measure of effect size between the two trial groups and the placebo group, with the placebo effect size value used as a reference.

I: Fluoxetine

Visit 1

4.92
units on CGI-S scale (Mean)
Standard Deviation: 0.95

Visit 2

2.54
units on CGI-S scale (Mean)
Standard Deviation: 1.13

Visit 3

2.33
units on CGI-S scale (Mean)
Standard Deviation: 1.00

Visit 4

2.56
units on CGI-S scale (Mean)
Standard Deviation: 1.13

Visit 5

2.5
units on CGI-S scale (Mean)
Standard Deviation: 0.76

II: Calcium

Visit 1

4.46
units on CGI-S scale (Mean)
Standard Deviation: 1.27

Visit 2

4.23
units on CGI-S scale (Mean)
Standard Deviation: 1.01

Visit 3

3.0
units on CGI-S scale (Mean)
Standard Deviation: 1.10

Visit 4

2.73
units on CGI-S scale (Mean)
Standard Deviation: 0.90

Visit 5

2.91
units on CGI-S scale (Mean)
Standard Deviation: 1.04

III: Placebo

Visit 1

4.15
units on CGI-S scale (Mean)
Standard Deviation: 1.28

Visit 2

3.38
units on CGI-S scale (Mean)
Standard Deviation: 1.66

Visit 3

3.38
units on CGI-S scale (Mean)
Standard Deviation: 1.98

Visit 4

2.92
units on CGI-S scale (Mean)
Standard Deviation: 1.50

Visit 5

3.17
units on CGI-S scale (Mean)
Standard Deviation: 1.47

Comparison of the Change in DRSP Symptom Scores Among Groups

DRSP = Daily Record of Severity of Problems, which combines responses to 21 items each with scale: 1=no symptoms, 6=extreme. This outcome is a measure of effect size between the two trial groups and the placebo group, with the placebo effect size value used as a reference.

I: Fluoxetine

Visit 1

2.16
units on DRSP scale (Mean)
Standard Deviation: 0.86

Visit 2

0.97
units on DRSP scale (Mean)
Standard Deviation: 0.72

Visit 3

0.27
units on DRSP scale (Mean)
Standard Deviation: 0.78

Visit 4

0.72
units on DRSP scale (Mean)
Standard Deviation: 0.78

Visit 5

0.44
units on DRSP scale (Mean)
Standard Deviation: 0.34

II: Calcium

Visit 1

1.12
units on DRSP scale (Mean)
Standard Deviation: 0.38

Visit 2

0.76
units on DRSP scale (Mean)
Standard Deviation: 0.78

Visit 3

0.61
units on DRSP scale (Mean)
Standard Deviation: 0.78

Visit 4

0.51
units on DRSP scale (Mean)
Standard Deviation: 0.33

Visit 5

0.75
units on DRSP scale (Mean)
Standard Deviation: 0.42

III: Placebo

Visit 1

1.29
units on DRSP scale (Mean)
Standard Deviation: 0.60

Visit 2

0.93
units on DRSP scale (Mean)
Standard Deviation: 0.54

Visit 3

1.19
units on DRSP scale (Mean)
Standard Deviation: 1.06

Visit 4

0.59
units on DRSP scale (Mean)
Standard Deviation: 0.63

Visit 5

0.74
units on DRSP scale (Mean)
Standard Deviation: 0.54

Comparison of the Change in CGI Improvement Scores Among Groups

CGI-I = Clinical Global Impression Improvement: the improvement subscale of CGI measuring change at each visit as compared to visit 1 (1=very much improved, 7=very much worse). This outcome is a measure of effect size between the two trial groups and the placebo group, with the placebo effect size value used as a reference.

I: Fluoxetine

Visit 1

Visit 2

2.23
units on CGI Improvement scale (Mean)
Standard Deviation: 0.83

Visit 3

1.67
units on CGI Improvement scale (Mean)
Standard Deviation: 0.87

Visit 4

1.75
units on CGI Improvement scale (Mean)
Standard Deviation: 1.16

Visit 5

1.88
units on CGI Improvement scale (Mean)
Standard Deviation: 0.64

II: Calcium

Visit 1

Visit 2

3.46
units on CGI Improvement scale (Mean)
Standard Deviation: 0.78

Visit 3

2.3
units on CGI Improvement scale (Mean)
Standard Deviation: 0.82

Visit 4

2.36
units on CGI Improvement scale (Mean)
Standard Deviation: 1.03

Visit 5

2.45
units on CGI Improvement scale (Mean)
Standard Deviation: 0.82

III: Placebo

Visit 1

Visit 2

3.0
units on CGI Improvement scale (Mean)
Standard Deviation: 1.35

Visit 3

3.08
units on CGI Improvement scale (Mean)
Standard Deviation: 1.50

Visit 4

2.77
units on CGI Improvement scale (Mean)
Standard Deviation: 1.17

Visit 5

2.83
units on CGI Improvement scale (Mean)
Standard Deviation: 1.19

Proportion of Participants With DRSP LOCF Response to Treatment (50% Improvement)

DRSP: Daily Record of Severity of Problems, which combines responses to 21 items each with scale: 1=no symptoms, 6=extreme. LOCF: the last observation carried forward.

I: Fluoxetine

0.8
proportion of participants

II: Calcium

0.42
proportion of participants

III: Placebo

0.42
proportion of participants

Proportion of Patients With PMTS Visit-wise Response to Treatment (50% Improvement)

Visit-wise response considers participants who remained in the study until Visit 5 and provided data for the visit. PMTS = Premenstrual Tension Syndrome (Observer Rating) Scale: a clinician-administered retrospective scale developed for the study of PMS, a sum of responses to 10 items each with 4 points (0=no symptoms, 40=most severe).

I: Fluoxetine

0.75
proportion of participants

II: Calcium

0.36
proportion of participants

III: Placebo

0.17
proportion of participants

Proportion of Participants With IDS LOCF Response to Treatment (50% Improvement)

IDS: Inventory of Depressive Symptomatology: measures depressive symptoms during the previous premenstrual phase with high internal consistency: sum of responses to 28 of 30 possible items each scored 0 to 3 points with total scoring (0=least severe, 84=most severe). LOCF: last observation carried forward.

I: Fluoxetine

0.77
proportion of participants

II: Calcium

0.31
proportion of participants

III: Placebo

0.31
proportion of participants

Proportion of Participants With PMTS LOCF Response to Treatment (50% Improvement)

PMTS: Premenstrual Tension Syndrome (Observer Rating) Scale: a clinician-administered retrospective scale developed for the study of PMS, a sum of responses to 10 items each with 4 points (0=no symptoms, 40=most severe). LOCF: last observation carried forward.

I: Fluoxetine

0.62
proportion of participants

II: Calcium

0.33
proportion of participants

III: Placebo

0.16
proportion of participants

Proportion of Participants With DRSP Visit-wise Response to Treatment (50% Improvement)

Visit-wise response considers participants who remained in the study until Visit 5 and provided data for the visit. DRSP = Daily Record of Severity of Problems, which combines responses to 21 items each with scale: 1=no symptoms, 6=extreme.

I: Fluoxetine

1.0
proportion of participants

II: Calcium

0.5
proportion of participants

III: Placebo

0.33
proportion of participants

Proportion of Patients With IDS Visit-wise Response to Treatment (50% Improvement)

Visit-wise response considers participants who remained in the study until Visit 5 and provided data for the visit. IDS = Inventory of Depressive Symptomatology: measures depressive symptoms during the previous premenstrual phase with high internal consistency, sum of responses to 28 of 30 possible items each scored 0 to 3 points with total scoring (0=no symptoms, 84=most severe).

I: Fluoxetine

1.0
proportion of participants

II: Calcium

0.36
proportion of participants

III: Placebo

0.33
proportion of participants

Total

39
Participants

Concurrent oral contraceptive use

10
participants

Ever spoken to a doctor about PMS

15
participants

OB-GYN asked about PMS

9
participants

Thought about getting help for PMS

20
participants

Age, Customized

Baseline Symptom Scores

Baseline Symptom Scores

Baseline Symptom Scores

Baseline Symptom Scores

Marital Status

Number of pregnancies

Race/Ethnicity, Customized

Region of Enrollment

Sex: Female, Male

Years with PMS

Overall Study

I: Fluoxetine

II: Calcium

III: Placebo

Drop/Withdrawal Reasons

I: Fluoxetine

II: Calcium

III: Placebo