Effective treatment of premenstrual violence in major depression: augmentation with aripiprazole

Premenstrual exacerbation of major depression is not uncommon. Premenstrual phase-related violence has also been reported. Serotonergic antidepressants, used both continuously and with increased dosage in the late luteal phase, are believed to be effective for major depressive disorder with premenstrual exacerbation. Adding a second medication for non-responder treatment is another treatment option. We present a 38-year-old woman suffering from major depression with premenstrual exacerbation of irritability and uncontrollable violence. The premenstrual exacerbation did not respond to increasing doses of selective serotonin reuptake inhibitor (SSRI) but a combination of an SSRI and late luteal phase aripiprazole was effective for her premenstrual violence. The serotonergic property of aripiprazole provides a synergic effect to SSRI for relieving premenstrual exacerbation of depression. The role of dopamine D2 as a partial agonist might further add to the effective alleviation of aggression and violence. An antidepressant with aripiprazole augmentation may be a treatment strategy for refractory premenstrual exacerbation and violence. Large-scale double blind placebo-controlled studies to verify efficacy are warranted.