Which medication is NOT the best first choice for anxiety/mood disorders related to premenstrual dysphoric disorder?

• A. Ethinyl estradiol/drospirenone (Yaz)
• B. Fluoxetine hydrochloride (Sarafem)
• C. Paroxetine (Paxil)
• D. Clonazepam (Klonopin)

Answer: (D)

In the context of treating anxiety and mood disorders associated with premenstrual dysphoric disorder (PMDD), certain medications have been established as first-line options based on their efficacy and safety profiles. Ethinyl estradiol/drospirenone, fluoxetine hydrochloride, and paroxetine have demonstrated effectiveness in alleviating PMDD symptoms.

Fluoxetine and paroxetine are both selective serotonin reuptake inhibitors (SSRIs), which are commonly prescribed for mood disorders, including PMDD, due to their ability to help regulate mood by increasing serotonin levels in the brain. Ethinyl estradiol/drospirenone is a combination oral contraceptive that has also been shown to be effective in managing PMDD symptoms, particularly hormonal fluctuations associated with the menstrual cycle.

In contrast, clonazepam, which is a benzodiazepine, is not typically considered a first-choice treatment for PMDD. While benzodiazepines can provide rapid relief for acute anxiety symptoms, they are not effective as a long-term solution for mood disorders. Additionally, their use is generally limited due to the risk of dependence and sedation, making them less suitable for the chronic management of conditions like PMDD. Thus, clonazepam is an appropriate option for addressing