--- title: Does escitalopram reduce aggressive behavior in women with premenstrual anger and irritability? description: Escitalopram reduced self-reported irritability and anger, and decreased aggressive behavior on one lab test but only in some women whose anger followed a spe url: https://niyora.com/research/papers/intermittent-escitalopram-treatment-and-reactive-aggression-in-women-with-2025/ --- - [Niyora](https://niyora.com/) - [Research](https://niyora.com/research/) - [Library](https://niyora.com/research/library/) - Does escitalopram reduce aggressive behavior in women with premenstrual anger and irritability? Randomised trial, 2025 # Does escitalopram reduce aggressive behavior in women with premenstrual anger and irritability? Escitalopram reduced self-reported irritability and anger, and decreased aggressive behavior on one lab test but only in some women whose anger followed a specific pattern. We can be moderately confident in this finding. Moderate study design 34 women with high levels of premenstrual irritability and anger ## What they did 34 women with high premenstrual irritability and anger tracked PMDD mood symptoms over three menstrual cycles. In cycles 2 and 3, they received escitalopram 20mg or placebo in random order (single-blind crossover), and in the luteal phase they completed two tests of aggressive behavior and rated their anger using a standardized scale. ## What they found Escitalopram reduced self-reported irritability and anger compared to placebo. It decreased aggressive responses on the Anger-Infused Ultimatum Game, but only in women who showed either a sharp premenstrual rise in outwardly expressed anger or no premenstrual rise in inwardly expressed anger. The other aggression test showed no difference. ## What it means for you Escitalopram may help reduce aggressive behavior in some women with severe premenstrual anger, but effects depend on how anger is expressed. The study only included women with high irritability/anger, so results may not apply to other PMDD symptoms. Effects were inconsistent across different tests. 34 women studied 20mg escitalopram dose 3 menstrual cycles tracked ## About the study Original title Intermittent escitalopram treatment and reactive aggression in women with premenstrual irritability and anger: A crossover study Authors Gröndal M, Näslund J, Englund C et al. Journal Journal of affective disorders Year 2025 Study design Randomised trial Participants 34 What was tested Escitalopram 20mg vs placebo, given intermittently during the luteal phase Open access Yes Read the paper [doi.org/10.1016/j.jad.2024.10.020](https://doi.org/10.1016/j.jad.2024.10.020) Original abstract Background: Selective serotonin reuptake inhibitors (SSRI) are the primary treatment for premenstrual mood symptoms and particularly effective in reducing reactive aggression in the forms of irritability and anger. The present study examined whether behavioral responses in laboratory measures of reactive aggression are influenced by medication with the SSRI escitalopram in women reporting high levels of premenstrual irritability/anger. Methods: Participants (N = 34) rated the cardinal mood symptoms of premenstrual dysphoric disorder over three menstrual cycles. During the second and third cycles, participants received escitalopram (20 mg) or placebo in a single-blind, cross-over design. In the luteal phase of the intervention cycles, participants completed two aggression tasks: The Anger-Infused Ultimatum Game (AI-UG) and the Point Subtraction Aggression Paradigm (PSAP). Additionally, they rated expression and control of anger using the State-Trait Anger Expression Inventory-2 (STAXI-2) once in the luteal phase and once in the follicular phase. Results: While irritability/anger was reduced in the treatment (vs. placebo) cycle, no effect of escitalopram was detected in the PSAP. Escitalopram decreased reactive aggressive behavior in the AI-UG but only for a subset of participants who experienced a sharp premenstrual rise in outwardly expressed anger and/or did not experience a premenstrual rise in inwardly expressed anger. Limitations: The participants' symptoms were based on the severity of only premenstrual irritability/anger, limiting the generalizability to the broader group of PMDD patients. Conclusion: The results suggest that the behavioral consequences of severe premenstrual irritability/anger are not easily captured by traditional measures of reactive aggression and underline the importance of considering individual differences in symptom expression. Reproduced under CC-BY. ## Topics [Premenstrual syndrome (PMS)](https://niyora.com/research/topics/condition-pms/)[Premenstrual dysphoric disorder (PMDD)](https://niyora.com/research/topics/condition-pmdd/)[Menstrual cycle and mood](https://niyora.com/research/topics/condition-cycle-mood/)[Low mood and depression](https://niyora.com/research/topics/symptom-depression-mood/)[Irritability and anger](https://niyora.com/research/topics/symptom-irritability-anger/)[SSRIs and antidepressants](https://niyora.com/research/topics/treatment-ssri/) Research tells you what helps on average. Niyora helps on the day it hits. Calm down, see it another way, and decide what to say, with a PMS and PMDD app built by a doctor. ## Related studies Randomised trial, 1998 Is intermittent citalopram during the luteal phase more effective than continuous dosing? Randomised trial, 1995 Does fluoxetine help premenstrual dysphoria? Randomised trial, 2025 Does escitalopram improve attention and reduce impulsivity in women with premenstrual irritability and anger? Cohort study, 2022 What are PMS and PMDD and how should they be diagnosed and treated? Randomised trial, 2017 Does Sepranolone reduce symptoms of severe premenstrual syndrome (PMDD)? Cohort study, 2012 How quickly does fluoxetine start working for PMDD symptoms? Ask AI about this page Copy prompt ChatGPT ↗ Claude ↗ Perplexity ↗ Google AI Mode ↗ Grok ↗