Fluoxetine for Premenstrual Dysphoria

To the Editor: The multicenter clinical trial of fluoxetine for the treatment of premenstrual mood symptoms reported by Steiner et al. (June 8 issue)¹ is good science but bad medicine. Cyclic changes in breast tenderness, fluid retention, nutrition, and emotional experiences are normal, are modulated by lifestyle, and are related to the emotional and social environment and culture. What evidence, other than help-seeking behavior, is there that the women in the study had pathologic depression requiring pharmacologic treatment?Was an inhibitor of serotonin reuptake tested because disturbances of serotonin are caused by normal hormonal changes during the menstrual cycle or . . .