Why this topic comes up in psychiatric practice

Premenstrual disorders include PMS and PMDD. PMDD is recognized as a depressive disorder and many patients seek care from OB-GYN, primary care, psychiatry, or a combination. obgyn boardpass

Evidence-based management is typically multimodal (often combining medical, psychological, and lifestyle strategies). obgynboardpass+1
ACOG recommends SSRIs, combined oral contraceptives (COCs), and cognitive behavioral therapy (CBT) as evidence-based options for premenstrual disorders. obgynboardpass+1

Some patients also ask about complementary options such as Vitex agnus-castus (“chaste tree berry”).

1) What is Vitex?

Vitex (chaste tree berry) is an herbal supplement used by some people for premenstrual symptoms (mood and physical symptoms). It is sold as a dietary supplement in the U.S.; supplements are regulated differently than prescription drugs and are not FDA-approved for treating PMDD. NCCIH

2) How Vitex may work

Vitex is thought to influence pituitary/hormone signaling, including effects related to prolactin and dopaminergic pathways. LactMed notes that some constituents may bind dopamine D2 receptors in the pituitary and describes dose-dependent effects reported in the literature. NCBI
Because this is a regulatory pathway, Vitex is generally taken daily, not “as needed.”

3) What does the evidence show?

The overall research signal is: some benefit for PMS symptoms (often physical symptoms), with variable study quality and product differences.

Key human evidence includes:

• Randomized, placebo-controlled PMS trial (3 cycles): Schellenberg et al. reported Vitex extract improved PMS symptoms versus placebo and was generally well tolerated. PubMed
• Meta-analysis of double-blind RCTs (PMS): Csupor et al. concluded Vitex preparations were superior to placebo in pooled analyses, while noting limitations in reporting and heterogeneity across trials. PubMed+1
• Preliminary PMDD comparative trial: Atmaca et al. compared fluoxetine vs Vitex extract in PMDD and found both groups improved; fluoxetine appeared more effective for psychological symptoms and Vitex more for physical symptoms. This is not definitive, but it is commonly cited as early comparative evidence. PubMed

Clinical interpretation (conservative): Vitex may be reasonable to discuss as an adjunct for selected patients, but it should not replace evidence-based PMDD care, and it requires careful screening for hormone/medication interactions.

4) Dosing guidance for Pure Encapsulations Chaste Tree (Vitex) 225 mg

Product referenced: Pure Encapsulations Chaste Tree (Vitex) 225 mg capsules

Common approach (start low, track symptoms):

• Start: 1 capsule once daily, with or between meals.
• If there is partial benefit and side effects are minimal, discuss with your clinician whether to increase to 1 capsule twice daily (morning + mid-afternoon).
• Time to assess benefit: plan for 2–3 menstrual cycles before deciding whether it helps (many studies and monographs evaluate use over multiple cycles). Health Canada’s monograph example also frames use over at least 3 months to see effects. Health Canada

Practical tips

• Take it at the same time each day.
• If it causes insomnia or jitteriness, take it earlier.
• Do not “stack” multiple Vitex products.

5) What to track (so you know if it’s truly helping)

Use a simple daily tracker (0–10) for:

• Irritability / depression / anxiety
• Breast tenderness
• Bloating/cramps/headache
• Sleep quality
• Functioning (work/relationships)

Bring the tracker to follow-up after 2–3 cycles. (Prospective tracking also helps confirm cyclical patterns versus an underlying mood/anxiety condition.)

6) Side effects and when to stop

Possible side effects can include:

• Headache
• Nausea / GI upset
• Dizziness
• Rash/itching
• Sleep changes
• Mood changes (irritability/agitation)
• Menstrual cycle changes (spotting, timing/flow changes) AAFP+1

Stop Vitex and seek prompt medical advice if you develop:

• Significant rash, facial swelling, trouble breathing
• Severe mood worsening or agitation
• Severe headache, confusion, or other concerning new symptoms

7) Critical safety requirement: you must get approval from BOTH your psychiatric prescriber AND OB-GYN/PCP

If you are considering Vitex for PMS/PMDD and you take any hormones (including birth control), you must obtain approval from:

1. Your psychiatric prescriber, and
2. Your OB-GYN (or primary care if you do not have an OB-GYN)

Why this matters

Regulatory and clinical references caution that Vitex may interact with hormone-containing medications, including oral contraceptives and hormone therapy.

• TGA (Australia) reported an unintended pregnancy with concurrent Vitex and a progestogen-only pill and states that Vitex may interfere with oral contraceptive effectiveness; it also advises consultation for medicines with contraceptive, hormonal, and/or dopaminergic actions. Therapeutic Goods Administration (TGA)
• Health Canada advises patients to ask a health professional before use if taking progesterone preparations, oral contraceptives, or hormone replacement therapy, and advises against use in pregnancy/breastfeeding/trying to conceive unless counseled. Health Canada
• A clinical advisory from SHVIC notes that a negative effect on contraceptive efficacy cannot be excluded based on reports. Sexual Health Victoria

Bottom line: Pregnancy prevention is high-stakes. Do not start Vitex if you use hormonal contraception or hormone therapy unless your OB-GYN/PCP explicitly agrees and your psychiatric prescriber confirms it is appropriate in your medication context.

8) Pregnancy, trying to conceive, and breastfeeding

Avoid Vitex if you are pregnant, breastfeeding, or trying to conceive unless your OB-GYN specifically recommends it. Health Canada lists this as a contraindication/caution area. Health Canada+1

9) Psychiatric medication interactions (and why we screen carefully)

Because Vitex may interact with dopaminergic and hormonal pathways, it may pose theoretical or practical concerns with certain medications.

Discuss with your prescriber before use if you take:

• Antipsychotics
• Parkinson’s medications (dopamine agonists)
• Other medicines with significant dopaminergic activity

TGA specifically flags the potential for interaction with medicines that have estrogenic and/or dopaminergic actions and recommends consultation before combined use. Therapeutic Goods Administration (TGA)

10) When to follow up

Reassess after 2–3 cycles with your clinician(s) to decide whether to:

• Continue
• Adjust the dose
• Switch or add evidence-based options (e.g., SSRI strategy, CBT, contraceptive strategy, or combined plan) obgynboardpass+1

FAQ (for the page)

Does Vitex treat PMDD?

Vitex has evidence for PMS in some studies and pooled analyses, but PMDD-specific evidence is limited and mixed. It should be considered an adjunct option only after clinician review. PubMed+1

How long does Vitex take to work?

Typically, you should assess over 2–3 cycles (about 2–3 months). Health Canada+1

Can Vitex interfere with birth control?

A negative effect on contraceptive efficacy cannot be excluded; regulatory agencies advise caution and clinician consultation. Therapeutic Goods Administration (TGA)+2Health Canada+2

Who should not take Vitex?

People who are pregnant, breastfeeding, trying to conceive, or taking hormone-containing medications unless advised by their OB-GYN/PCP; and anyone where their prescriber advises against it due to medication interactions. Health Canada+2Therapeutic Goods Administration (TGA)+2

References

1. American College of Obstetricians and Gynecologists (ACOG). Clinical Practice Guideline No. 7: Management of Premenstrual Disorders (Dec 2023). obgynboardpass+2obgynboardpass+2
2. National Center for Complementary and Integrative Health (NCCIH/NIH). Chasteberry: Usefulness and Safety (accessed page). NCCIH
3. Therapeutic Goods Administration (Australia). Vitex agnus-castus: Safety advisory – potential for interaction with oral contraceptives (May 2, 2019). Therapeutic Goods Administration (TGA)
4. Health Canada. Chaste Tree – Vitex agnus-castus monograph (warnings re: hormone-containing medications; pregnancy/breastfeeding cautions). Health Canada
5. Schellenberg R. Treatment for the premenstrual syndrome with agnus castus fruit extract: randomized placebo-controlled study. BMJ (2001). PubMed
6. Csupor D, et al. Vitex agnus-castus in premenstrual syndrome: meta-analysis of double-blind randomized trials. Complement Ther Med (2019). PubMed+1
7. Atmaca M, et al. Fluoxetine versus Vitex agnus castus extract in PMDD. Hum Psychopharmacol (2003). PubMed
8. LactMed (NCBI Bookshelf). Chasteberry (Vitex agnus-castus) – Drugs and Lactation Database (Last revision Nov 15, 2024). NCBI
9. Sexual Health Victoria (SHVIC). Effect of Vitex agnus-castus on hormonal contraception (Dec 2020). Sexual Health Victoria