Which of the following medications is an alternative treatment for PMS if SSRIs are ineffective?

Buspirone is an anxiolytic that can be considered as an alternative treatment for Premenstrual Syndrome (PMS) when selective serotonin reuptake inhibitors (SSRIs) have not provided sufficient relief. While SSRIs are a first-line treatment for PMS and premenstrual dysphoric disorder (PMDD), buspirone may help alleviate anxiety and other symptoms associated with PMS.

The use of buspirone in this context is based on its effectiveness in managing anxiety without the risk of dependence that comes with benzodiazepines. It acts as a serotonin receptor agonist and may contribute to mood stabilization, which can be beneficial for individuals experiencing PMS symptoms.

In contrast, other medications listed, like Duloxetine and Paroxetine, are SSRIs or serotonin-norepinephrine reuptake inhibitors (SNRIs) themselves, which would normally be considered within the SSRI treatment category. They wouldn’t typically be classified as alternatives when SSRIs have failed since they work on similar neurotransmitter systems. Alprazolam, while providing symptomatic relief for anxiety, is a benzodiazepine, and its use in this context may be limited due to concerns about dependency and the potential for withdrawal symptoms.

Buspirone's unique profile makes it suitable