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Tonon AC, Ramos-Lima LF, Kuhathasan N, Frey BN. Early Life Trauma, Emotion Dysregulation and Hormonal Sensitivity Across Female Reproductive Life Events. Curr Psychiatry Rep 2024; 26:530-542. [PMID: 39187611 DOI: 10.1007/s11920-024-01527-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2024] [Indexed: 08/28/2024]
Abstract
PURPOSE OF REVIEW To explore the relationship between early life trauma, hormonal sensitivity, and psychiatric disorders across female-reproductive life events, with a focus on the neurobiological mechanisms. RECENT FINDINGS Childhood trauma significantly increases the risk of subsequent mood disorders during periods of intense hormonal fluctuation such as premenstrual, pregnancy, postpartum, and perimenopause. Neurobiological changes resulting from early trauma influence emotion regulation, which emerges as a key predisposing, exacerbating, and perpetuating factor to hormonal sensitivity and subsequent psychiatric symptoms. We identified altered stress response and allopregnanolone imbalance, bias in cognitive processing of emotions, neuroimage correlates and sleep disturbances as potential underlying neurobiological mechanisms. This review integrates cumulative findings supporting a theoretical framework linking early life trauma to hormonal sensitivity and mood disorders. We propose that some women might be more susceptible to such hormonal fluctuations because of emotion dysregulation following significant early life trauma.
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Affiliation(s)
- André C Tonon
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada
| | - Luis Francisco Ramos-Lima
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada
| | - Nirushi Kuhathasan
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada
| | - Benicio N Frey
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.
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Mulligan EM, Eisenlohr-Moul TA, Nagpal A, Schmalenberger KM, Eckel L, Hajcak G. Characterizing within-person variance in, and menstrual cycle associations with, event-related potentials associated with positive and negative valence systems: The reward positivity and the error-related negativity. Psychoneuroendocrinology 2024; 170:107183. [PMID: 39303429 DOI: 10.1016/j.psyneuen.2024.107183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 08/04/2024] [Accepted: 09/10/2024] [Indexed: 09/22/2024]
Abstract
Event-related potentials (ERPs) are widely employed as measures of transdiagnostic cognitive processes that are thought to underlie various clinical disorders (Hajcak et al., 2019). Despite their prevalent use as individual difference measures, the effects of within-person processes, such as the human menstrual cycle, on a broad range of ERPs are poorly understood. The present study leveraged a within-subject design to characterize between- and within-person variance in ERPs as well as effects of the menstrual cycle in two frequently studied ERPs associated with positive and negative valence systems underlying psychopathology-the Reward Positivity (RewP) and the Error- Related Negativity (ERN). Seventy-one naturally-cycling participants completed repeated EEG and ecological momentary assessments of positive and negative affect in the menstrual cycle's early follicular, periovulatory, and mid-luteal phases. We examined the mean degree of change between cycle phases in both ERPs, the between-person variability in the degree of change in both ERPs, and whether an individual's degree of cyclical change in these ERPs show coherence with their degree of cyclical change in positive and negative affect recorded across the cycle. Results revealed no significant changes in positive and negative affect across the cycle and rather small changes in ERP amplitudes. Significant random slopes in our model revealed larger individual differences in trajectories of change in ERP amplitudes and affect, in agreement with prior evidence of heterogeneity in dimensional hormone sensitivity. Additionally, state-variance in these ERPs correlated with positive and negative affect changes across the cycle, suggesting that cycle-mediated ERP changes may have relevance for affect and behavior. Finally, exploratory latent class growth mixture modeling revealed subgroups of individuals that display disparate patterns of change in ERPs that should be further investigated.
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Affiliation(s)
| | | | - Anisha Nagpal
- Department of Psychiatry, The University of Illinois at Chicago, USA
| | | | - Lisa Eckel
- Department of Psychology, Florida State University, USA
| | - Greg Hajcak
- Department of Psychology, Florida State University, USA; Department of Biomedical Sciences, Florida State University, USA; School of Education and Counseling Psychology, Santa Clara University, USA
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Andersen EH, Nagpal A, Eisenlohr-Moul TA, Gordon JL. A novel method for quantifying affective sensitivity to endogenous ovarian hormones. Psychoneuroendocrinology 2024; 167:107095. [PMID: 38896987 DOI: 10.1016/j.psyneuen.2024.107095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/30/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024]
Abstract
Increased sensitivity to ovarian hormone changes is implicated in the etiology of reproductive mood disorders across the female lifespan, including menstrually-related mood disorders, perinatal mood disorders, and perimenopausal depression. Developing a method to accurately quantify sensitivity to endogenous hormone fluctuations may therefore facilitate the prediction and prevention of these mental health conditions. Here, we propose one such method applying a synchrony analysis to compute time-lagged cross-correlations between repeated assessments of endogenous hormone levels and self-reported affect. We apply this method to a dataset containing frequent repeated assessments of affective symptoms and the urinary metabolites of estradiol (E2) and progesterone (P4) in 94 perimenopausal females. These preliminary findings suggest that, with further refinement and validation, the proposed method holds promise as a diagnostic tool to be used in clinical practice and to advance research investigating the etiology of reproductive mood disorders.
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Affiliation(s)
- Elizabeth H Andersen
- Department of Psychiatry, Faculty of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anisha Nagpal
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Jennifer L Gordon
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada.
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Verma A, Inslicht SS, Bhargava A. Gut-Brain Axis: Role of Microbiome, Metabolomics, Hormones, and Stress in Mental Health Disorders. Cells 2024; 13:1436. [PMID: 39273008 PMCID: PMC11394554 DOI: 10.3390/cells13171436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 08/19/2024] [Accepted: 08/23/2024] [Indexed: 09/15/2024] Open
Abstract
The influence of gut microbiome, metabolites, omics, hormones, and stress on general and mental health is increasingly being recognized. Ancient cultures recognized the importance of diet and gut health on the overall health of an individual. Western science and modern scientific methods are beginning to unravel the foundations and mechanisms behind some of the ancient beliefs and customs. The gut microbiome, an organ itself, is now thought to influence almost all other organs, ranging from the brain to the reproductive systems. Gut microbiome, metabolites, hormones, and biological sex also influence a myriad of health conditions that range from mental health disorders, obesity, gastrointestinal disorders, and cardiovascular diseases to reproductive health. Here, we review the history and current understanding of the gut-brain axis bidirectional talk in various mental health disorders with special emphasis on anxiety and depressive disorders, whose prevalence has increased by over 50% in the past three decades with COVID-19 pandemic being the biggest risk factor in the last few years. The vagal nerve is an important contributor to this bidirectional talk, but other pathways also contribute, and most remain understudied. Probiotics containing Lactobacillus and Bifidobacterium species seem to have the most impact on improvement in mental health symptoms, but the challenge appears to be maintaining sustained levels, especially since neither Lactobacillus nor Bifidobacterium can permanently colonize the gut. Ancient endogenous retroviral DNA in the human genome is also linked to several psychiatric disorders, including depression. These discoveries reveal the complex and intricately intertwined nature of gut health with mental health disorders.
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Affiliation(s)
- Ankita Verma
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California at San Francisco, 513 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Sabra S Inslicht
- San Francisco VA Health Care System, San Francisco, CA 94121, USA
- Department of Psychiatry and Behavioral Sciences, University of California at San Francisco, San Francisco, CA 94143, USA
| | - Aditi Bhargava
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California at San Francisco, 513 Parnassus Avenue, San Francisco, CA 94143, USA
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Peters JR, Schmalenberger KM, Eng AG, Stumper A, Martel MM, Eisenlohr-Moul TA. Dimensional Affective Sensitivity to Hormones across the Menstrual Cycle (DASH-MC): A transdiagnostic framework for ovarian steroid influences on psychopathology. Mol Psychiatry 2024:10.1038/s41380-024-02693-4. [PMID: 39143323 DOI: 10.1038/s41380-024-02693-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 07/31/2024] [Accepted: 08/05/2024] [Indexed: 08/16/2024]
Abstract
Fluctuations in progesterone (P4) and estradiol (E2) across the menstrual cycle can exert direct effects on biological systems implicated in neuropsychiatric disorders and represent a key biological source of variability in affective, cognitive, and behavioral disorders. Although these cyclical symptoms may be most readily identified when they occur exclusively in relation to the menstrual cycle, as in DSM-5 premenstrual dysphoric disorder, symptom changes of similar magnitude occur in a larger proportion of people with ongoing psychiatric disorders. Studies investigating cyclical regulation of brain and behavior often produce inconsistent results, which may be attributed to a lack of focus on specific hormonal events and individual differences in related sensitivities. We propose a transdiagnostic Dimensional Affective Sensitivity to Hormones across the Menstrual Cycle (DASH-MC) framework, postulating that atypical neural responses to several key hormonal events provoke specific temporal patterns of affective and behavioral change across the menstrual cycle. We review prospective and experimental evidence providing initial support for these dimensions, which include (1) luteal-onset negative affect caused by a sensitivity to E2 or P4 surges (mediated by neuroactive metabolites such as allopregnanolone), typified by irritability and hyperarousal; (2) perimenstrual-onset negative affect caused by a sensitivity to low or falling E2, typified by low mood and cognitive dysfunction; and (3) preovulatory-onset positive affect dysregulation caused by a sensitivity to E2 surges, typified by harmful substance use and other risky reward-seeking. This multidimensional, transdiagnostic framework for hormone sensitivity can inform more precise research on ovarian steroid regulation of psychopathology, including further mechanistic research, diagnostic refinement, and precision psychiatry treatment development. Additionally, given the high rates of hormone sensitivity across affective disorders, the DASH-MC may guide broader insights into the complex neurobiological vulnerabilities driving female-biased affective risk, as well as potential triggers and mechanisms of affective state change in psychiatric disorders.
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Affiliation(s)
- Jessica R Peters
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
| | | | - Ashley G Eng
- Department of Psychology, University of Kentucky, Lexington, KY, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Allison Stumper
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | - Michelle M Martel
- Department of Psychology, University of Kentucky, Lexington, KY, USA
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Schmalenberger KM, Eisenlohr-Moul TA, Jarczok MN, Schneider E, Barone JC, Thayer JF, Ditzen B. Associations of luteal phase changes in vagally mediated heart rate variability with premenstrual emotional changes. BMC Womens Health 2024; 24:448. [PMID: 39118058 PMCID: PMC11308668 DOI: 10.1186/s12905-024-03273-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 07/18/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND A recent meta-analysis revealed that vagally mediated heart rate variability (vmHRV; a biomarker of emotion regulation capacity) significantly decreases in the luteal phase of the menstrual cycle. As two follow-up studies suggest, these vmHRV decreases are driven primarily by increased luteal progesterone (P4). However, analyses also revealed significant interindividual differences in vmHRV reactivity to the cycle, which is in line with longstanding evidence for interindividual differences in mood sensitivity to the cycle. The present study begins to investigate whether these interindividual differences in vmHRV cyclicity can explain who is at higher risk of showing premenstrual emotional changes. We expected a greater degree of midluteal vmHRV decrease to be predictive of a greater premenstrual increase in negative affect. METHODS We conducted an observational study with a naturally cycling community sample (N = 31, M = 26.03 years). Over a span of six weeks, participants completed (a) daily ratings of negative affect and (b) counterbalanced lab visits in their ovulatory, midluteal, and perimenstrual phases. Lab visits were scheduled based on positive ovulation tests and included assessments of baseline vmHRV and salivary ovarian steroid levels. RESULTS In line with previous research, multilevel models suggest that most of the sample shows ovulatory-to-midluteal vmHRV decreases which, however, were not associated with premenstrual emotional changes. Interestingly, it was only the subgroup with luteal increases in vmHRV whose negative affect markedly worsened premenstrually and improved postmenstrually. CONCLUSION The present study begins to investigate cyclical changes in vmHRV as a potential biomarker of mood sensitivity to the menstrual cycle. The results demonstrate a higher level of complexity in these associations than initially expected, given that only atypical midluteal increases in vmHRV are associated with greater premenstrual negative affect. Potential underlying mechanisms are discussed, among those the possibility that luteal vmHRV increases index compensatory efforts to regulate emotion in those with greater premenstrual negative affect. However, future studies with larger and clinical samples and more granular vmHRV assessments should build on these findings and further explore associations between vmHRV cyclicity and menstrually related mood changes.
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Affiliation(s)
- Katja M Schmalenberger
- Department of Psychiatry, University of Illinois at Chicago, 1747 W. Roosevelt Rd., Chicago, IL, 60612, USA.
- Institute of Medical Psychology, Center for Psychosocial Medicine (ZPM), Heidelberg University Hospital, Ruprecht Karl University of Heidelberg, Bergheimer Str. 20, Heidelberg, 69115, Germany.
| | - Tory A Eisenlohr-Moul
- Department of Psychiatry, University of Illinois at Chicago, 1747 W. Roosevelt Rd., Chicago, IL, 60612, USA
| | - Marc N Jarczok
- Clinic for Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Albert-Einstein-Allee 23, Ulm, 89081, Germany
| | - Ekaterina Schneider
- Institute of Medical Psychology, Center for Psychosocial Medicine (ZPM), Heidelberg University Hospital, Ruprecht Karl University of Heidelberg, Bergheimer Str. 20, Heidelberg, 69115, Germany
| | - Jordan C Barone
- Department of Psychiatry, University of Illinois at Chicago, 1747 W. Roosevelt Rd., Chicago, IL, 60612, USA
| | - Julian F Thayer
- Department of Psychological Science, School of Social Ecology, University of California Irvine, 5300 Social and Behavioral Sciences Gateway, Irvine, CA, 92697, USA
| | - Beate Ditzen
- Institute of Medical Psychology, Center for Psychosocial Medicine (ZPM), Heidelberg University Hospital, Ruprecht Karl University of Heidelberg, Bergheimer Str. 20, Heidelberg, 69115, Germany
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Memi E, Pavli P, Papagianni M, Vrachnis N, Mastorakos G. Diagnostic and therapeutic use of oral micronized progesterone in endocrinology. Rev Endocr Metab Disord 2024; 25:751-772. [PMID: 38652231 PMCID: PMC11294403 DOI: 10.1007/s11154-024-09882-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 04/25/2024]
Abstract
Progesterone is a natural steroid hormone, while progestins are synthetic molecules. In the female reproductive system, progesterone contributes to the control of luteinizing hormone and follicle-stimulating hormone secretion and their pulsatility, via its receptors on the kisspeptin, neurokinin B, and dynorphin neurons in the hypothalamus. Progesterone together with estradiol controls the cyclic changes of proliferation and decidualization of the endometrium; exerts anti-mitogenic actions on endometrial epithelial cells; regulates normal menstrual bleeding; contributes to fertilization and pregnancy maintenance; participates in the onset of labor. In addition, it exerts numerous effects on other endocrine systems. Micronized progesterone (MP) is natural progesterone with increased bioavailability, due to its pharmacotechnical micronized structure, which makes it an attractive diagnostic and therapeutic tool. This critical literature review aims to summarize and put forward the potential diagnostic and therapeutic uses of MP in the field of endocrinology. During reproductive life, MP is used for diagnostic purposes in the evaluation of primary or secondary amenorrhea as a challenge test. Moreover, it can be prescribed to women presenting with amenorrhea or oligomenorrhea for induction of withdrawal bleeding, in order to time blood-sampling for diagnostic purposes in early follicular phase. Therapeutically, MP, alone or combined with estrogens, is a useful tool in various endocrine disorders including primary amenorrhea, abnormal uterine bleeding due to disordered ovulation, luteal phase deficiency, premenstrual syndrome, polycystic ovary syndrome, secondary amenorrhea [functional hypothalamic amenorrhea, premature ovarian insufficiency], perimenopause and menopause. When administrated per os, acting as a neurosteroid directly or through its metabolites, it exerts beneficial effects on brain function such as alleviation of symptoms of anxiety and depression, asw well as of sleep problems, while it improves working memory in peri- and menopausal women. Micronized progesterone preserves full potential of progesterone activity, without presenting many of the side-effects of progestins. Although it has been associated with more frequent drowsiness and dizziness, it can be well tolerated with nocturnal administration. Because of its better safety profile, especially with regard to metabolic ailments, breast cancer risk and veno-thromboembolism risk, MP is the preferred option for individuals with an increased risk of cardiovascular and metabolic diseases and of all-cause mortality.
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Affiliation(s)
- Eleni Memi
- Unit of Endocrinology, Diabetes mellitus, and Metabolism, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Vas. Sophias Av. 76, 11528, Athens, Greece
| | - Polina Pavli
- Unit of Endocrinology, Diabetes mellitus, and Metabolism, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Vas. Sophias Av. 76, 11528, Athens, Greece
| | - Maria Papagianni
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42100, Trikala, Greece
- Endocrine Unit, 3rd Department of Pediatrics, Hippokration Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54642, Thessaloniki, Greece
| | - Nikolaos Vrachnis
- Third Department of Obstetrics and Gynecology, Attikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini Str. 1, 12462, Chaidari, Athens, Greece
- St George's NHS Foundation Trust Teaching Hospitals, St George's University of London, London, UK
| | - George Mastorakos
- Unit of Endocrinology, Diabetes mellitus, and Metabolism, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Vas. Sophias Av. 76, 11528, Athens, Greece.
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Liu X, Li R, Wang S, Zhang J. Global, regional, and national burden of premenstrual syndrome, 1990-2019: an analysis based on the Global Burden of Disease Study 2019. Hum Reprod 2024; 39:1303-1315. [PMID: 38689567 DOI: 10.1093/humrep/deae081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/22/2024] [Indexed: 05/02/2024] Open
Abstract
STUDY QUESTION What is the burden of premenstrual syndrome (PMS) at the global, regional, and national levels across 21 regions and 204 countries and territories? SUMMARY ANSWER Over the past few decades, the global prevalent cases of PMS have grown significantly from 652.5 million in 1990 to 956.0 million in 2019, representing a 46.5% increase. WHAT IS KNOWN ALREADY PMS, which affects almost half of reproductive women worldwide, has substantial social, occupational, academic, and psychological effects on women's lives. However, no comprehensive and detailed epidemiological estimates of PMS by age and socio-demographic index (SDI) at global, regional, and national levels have been reported. STUDY DESIGN, SIZE, DURATION An age- and SDI-stratified systematic analysis of the prevalence and years lived with disability (YLD) of PMS by age and SDI across 21 regions and 204 countries and territories has been performed. PARTICIPANTS/MATERIALS, SETTING, METHODS The prevalence and YLD of PMS from 1990 to 2019 were retrieved directly from the Global Burden of Diseases (GBD) 2019 study. The number, rates per 100 000 persons, and average annual percentage changes (AAPCs) of prevalence and YLD were estimated at the global, regional, and national levels. MAIN RESULTS AND THE ROLE OF CHANCE Globally, the prevalent cases of PMS increased by 46.5% from 652.5 million in 1990 to 956.0 million in 2019; in contrast, however, the age-standardized prevalence rate was approximately stable at 24 431.15/100 000 persons in 1990 and 24 406.51/100 000 persons in 2019 (AAPC, 0[95% CI: -0.01 to 0.01]). Globally, the YLD was 8.0 million in 2019 and 5.4 million in 1990, with a sizable increase over the past 30 years. The age-standardized YLD rate was stable (AAPC 0.01, P = 0.182), at 203.45/100 000 persons in 1990 and 203.76/100 000 persons in 2019. The age-standardized burden estimates were the highest in the low-middle SDI regions and the lowest in the high SDI regions. Peaks in burden rate estimates were all observed in the 40-44 years age group. Regional age-standardized burden estimates were the highest in South Asia and the lowest in Western Sub-Saharan Africa. The national age-standardized burden estimates were the highest in Pakistan and the lowest in Niger. LIMITATIONS, REASONS FOR CAUTION The accuracy of the results depended on the quality and quantity of the GBD 2019 data. Fortunately, the GBD study endeavoured to retrieve data globally and applied multiple models to optimize the completeness, accuracy, and reliability of the data. In addition, the GBD study took the country as its basic unit and neglected the influence of race. Further study is warranted to compare differences in PMS burden associated with race. Finally, no data are available on the aetiology and risk information related to PMS, which might help us to better understand the trends and age distribution of PMS and help local governments formulate more detailed policies and comprehensive interventions. WIDER IMPLICATIONS OF THE FINDINGS Although the age-standardized prevalence/YLD rate has been stable over the past 30 years, the absolute number of prevalent cases and YLD grew significantly worldwide from 1990 to 2019. Public health-related policies should be implemented to reduce the prevalence and alleviate the symptoms of PMS. Lifestyle changes and cognitive-behavioral therapy are critical in helping to reduce the burden of PMS. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by the National Key Research and Development Program of China (grant number 2022YFC2704100) and the National Natural Science Foundation of China (No. 82001498, No. 82371648). The authors declare no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Xingyu Liu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- National Clinical Research Center for Obstetrical and Gynecological Diseases, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Huazhong University of Science and Technology, Wuhan, China
| | - Ruyuan Li
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shixuan Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- National Clinical Research Center for Obstetrical and Gynecological Diseases, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Huazhong University of Science and Technology, Wuhan, China
| | - Jinjin Zhang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- National Clinical Research Center for Obstetrical and Gynecological Diseases, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Huazhong University of Science and Technology, Wuhan, China
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Andersen E, Klusmann H, Eisenlohr-Moul T, Baresich K, Girdler S. Life stress influences the relationship between sex hormone fluctuation and affective symptoms in peripubertal female adolescents. Dev Psychopathol 2024; 36:821-833. [PMID: 36876646 PMCID: PMC10480354 DOI: 10.1017/s095457942300010x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Female adolescents have a greatly increased risk of depression starting at puberty, which continues throughout the reproductive lifespan. Sex hormone fluctuation has been highlighted as a key proximal precipitating factor in the development of mood disorders tied to reproductive events; however, hormone-induced affective state change is poorly understood in the pubertal transition. The present study investigated the impact of recent stressful life events on the relationship between sex hormone change and affective symptoms in peripubertal female participants. Thirty-five peripubertal participants (ages 11-14, premenarchal, or within 1 year of menarche) completed an assessment of stressful life events, and provided weekly salivary hormone collections [estrone, testosterone, dehydroepiandrosterone (DHEA)] and mood assessments for 8 weeks. Linear mixed models tested whether stressful life events provided a context in which within-person changes in hormones predicted weekly affective symptoms. Results indicated that exposure to stressful life events proximal to the pubertal transition influenced the directional effects of hormone change on affective symptoms. Specifically, greater affective symptoms were associated with increases in hormones in a high stress context and decreases in hormones in a low stress context. These findings provide support for stress-related hormone sensitivity as a diathesis for precipitating affective symptoms in the presence of pronounced peripubertal hormone flux.
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Affiliation(s)
- Elizabeth Andersen
- University of North Carolina, Department of Psychiatry. CB #7167, Chapel Hill, NC 27617
| | - Hannah Klusmann
- University of North Carolina, Department of Psychiatry. CB #7167, Chapel Hill, NC 27617
- Freie Universität Berlin, Division of Clinical Psychological Intervention, Department of Education and Psychology. Schwendenerstraße 27, 14195 Berlin, Germany
| | - Tory Eisenlohr-Moul
- University of Illinois at Chicago, Department of Psychiatry, MC 913, Chicago, IL 60612
| | - Kayla Baresich
- University of North Carolina, Department of Psychiatry. CB #7167, Chapel Hill, NC 27617
| | - Susan Girdler
- University of North Carolina, Department of Psychiatry. CB #7167, Chapel Hill, NC 27617
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Haußmann J, Goeckenjan M, Haußmann R, Wimberger P. [Premenstrual syndrome and premenstrual dysphoric disorder-Overview on pathophysiology, diagnostics and treatment]. DER NERVENARZT 2024; 95:268-274. [PMID: 38393358 PMCID: PMC10914875 DOI: 10.1007/s00115-024-01625-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 02/25/2024]
Abstract
Premenstrual syndrome and premenstrual dysphoric disorder become episodically manifest during the second half of the female menstrual cycle and are characterized by psychological and physical symptoms causing relevant functional and social impairments. Mood swings, depression and dysphoria are associated depressive symptoms. Therefore, affective disorders should be considered as a differential diagnosis. Of women in reproductive age 3-8% suffer from premenstrual syndrome and 2% of women are affected by premenstrual dysphoric disorder. Genetic and sociobiographical risk factors are discussed. Furthermore, genetic polymorphisms of specific hormone receptors are considered to be genetic risk factors. From a pathophysiological perspective premenstrual syndrome and premenstrual dysphoric disorder are caused by a complex interaction between cyclic changes of ovarian steroids and central neurotransmitters. An imbalance of estrogen and progesterone in the luteal phase is believed to cause the symptoms. Therefore, the first treatment approach consists of regulation of the menstrual cycle or luteal support with progesterone or synthetic progestins even if their effectiveness has not yet been proven in randomized controlled studies and meta-analyses. The administration of combined oral contraceptives is also an option. Especially treatment with selective serotonin reuptake inhibitors (SSRI) represent an evidence-based approach. In severe cases the administration of gonadotropin releasing hormone (GnRH) agonists with add back treatment can also be considered. In the field of affective disorders premenstrual syndromes represent clinically relevant differential diagnoses and comorbidities, which confront the treating physician with particular clinical challenges. Therefore, this literature review gives the readership a clinical orientation for dealing with these disorders.
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Affiliation(s)
- Jana Haußmann
- Klinik und Poliklinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - M Goeckenjan
- Klinik und Poliklinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - R Haußmann
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - P Wimberger
- Klinik und Poliklinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
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11
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Ross JM, Barone JC, Tauseef H, Schmalenberger KM, Nagpal A, Crane NA, Eisenlohr-Moul TA. Predicting Acute Changes in Suicidal Ideation and Planning: A Longitudinal Study of Symptom Mediators and the Role of the Menstrual Cycle in Female Psychiatric Outpatients With Suicidality. Am J Psychiatry 2024; 181:57-67. [PMID: 38093647 PMCID: PMC11031249 DOI: 10.1176/appi.ajp.20230303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2024]
Abstract
OBJECTIVE Cross-sectional and preliminary longitudinal findings suggest that cyclical ovarian hormone fluctuations influence acute suicide risk. The authors provide the first analyses in females with suicidality to investigate which daily symptoms covary with suicidal ideation and planning thoughts, the role of the menstrual cycle in daily symptom variation, how daily fluctuations in symptoms mediate the menstrual cycle-suicidality relationship, and how these associations vary across individuals. METHODS Naturally cycling psychiatric outpatients (N=119) with past-month suicidal ideation provided daily ratings of psychiatric symptoms (depression, hopelessness, anxiety, feeling overwhelmed, agitation, anhedonia, worthlessness, rejection sensitivity, anger, perceived burdensomeness, and interpersonal conflict), suicidal ideation, and suicidal planning across at least one menstrual cycle. Symptom ratings were decomposed into trait (person-centered mean) and state (daily person-centered mean deviation) components. Five cycle phases were identified in relation to menses onset and ovulation (surge in urine luteinizing hormone level). Hypotheses were tested in multilevel structural equation models. RESULTS Nearly all psychiatric symptoms covaried with fluctuations in daily suicidal ideation, and a limited set of symptoms (depression, hopelessness, rejection sensitivity, and perceived burdensomeness) predicted within-person increases in suicidal planning. Many patients demonstrated perimenstrual worsening of psychiatric symptoms, suicidal ideation, and suicidal planning. Depressive symptoms (depression, hopelessness, perceived burdensomeness, and anhedonia) were the most robust statistical mediators predicting perimenstrual exacerbation of suicidality. CONCLUSIONS Research on the menstrual cycle and suicide has been limited historically by small, cross-sectional samples. This study provides the first evidence that measuring day-to-day correlates of suicidality in a large transdiagnostic sample of females with suicidal ideation can contribute to understanding the pathways by which the menstrual cycle influences acute suicide risk.
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Affiliation(s)
- Jaclyn M Ross
- Department of Psychiatry, College of Medicine, University of Illinois at Chicago
| | - Jordan C Barone
- Department of Psychiatry, College of Medicine, University of Illinois at Chicago
| | - Hafsah Tauseef
- Department of Psychiatry, College of Medicine, University of Illinois at Chicago
| | | | - Anisha Nagpal
- Department of Psychiatry, College of Medicine, University of Illinois at Chicago
| | - Natania A Crane
- Department of Psychiatry, College of Medicine, University of Illinois at Chicago
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12
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Kaltsouni E, Schmidt F, Zsido RG, Eriksson A, Sacher J, Sundström-Poromaa I, Sumner RL, Comasco E. Electroencephalography findings in menstrually-related mood disorders: A critical review. Front Neuroendocrinol 2024; 72:101120. [PMID: 38176542 DOI: 10.1016/j.yfrne.2023.101120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 12/21/2023] [Accepted: 12/31/2023] [Indexed: 01/06/2024]
Abstract
The female reproductive years are characterized by fluctuations in ovarian hormones across the menstrual cycle, which have the potential to modulate neurophysiological and behavioral dynamics. Menstrually-related mood disorders (MRMDs) comprise cognitive-affective or somatic symptoms that are thought to be triggered by the rapid fluctuations in ovarian hormones in the luteal phase of the menstrual cycle. MRMDs include premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), and premenstrual exacerbation (PME) of other psychiatric disorders. Electroencephalography (EEG) non-invasively records in vivo synchronous activity from populations of neurons with high temporal resolution. The present overview sought to systematically review the current state of task-related and resting-state EEG investigations on MRMDs. Preliminary evidence indicates lower alpha asymmetry at rest being associated with MRMDs, while one study points to the effect being luteal-phase specific. Moreover, higher luteal spontaneous frontal brain activity (slow/fast wave ratio as measured by the delta/beta power ratio) has been observed in persons with MRMDs, while sleep architecture results point to potential circadian rhythm disturbances. In this review, we discuss the quality of study designs as well as future perspectives and challenges of supplementing the diagnostic and scientific toolbox for MRMDs with EEG.
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Affiliation(s)
- Elisavet Kaltsouni
- Department of Womeńs and Childreńs Health, Science for Life Laboratory, Uppsala University, Sweden
| | - Felix Schmidt
- Department of Womeńs and Childreńs Health, Science for Life Laboratory, Uppsala University, Sweden; Centre for Women's Mental Health during the Reproductive Lifespan, Uppsala University, 751 85 Uppsala, Sweden
| | - Rachel G Zsido
- Cognitive Neuroendocrinology, Max Planck Institute for Human Cognitive and Brain Sciences, Germany; Department of Psychiatry, Clinical Neuroscience Laboratory for Sex Differences in the Brain, Massachusetts General Hospital, Harvard Medical School, USA
| | - Allison Eriksson
- Centre for Women's Mental Health during the Reproductive Lifespan, Uppsala University, 751 85 Uppsala, Sweden; Department of Womeńs and Childreńs Health, Uppsala University, Sweden
| | - Julia Sacher
- Cognitive Neuroendocrinology, Max Planck Institute for Human Cognitive and Brain Sciences, Germany; Clinic of Cognitive Neurology, University of Leipzig, Germany
| | | | | | - Erika Comasco
- Department of Womeńs and Childreńs Health, Science for Life Laboratory, Uppsala University, Sweden.
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13
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Johnson CE, Duncan MJ, Murphy MP. Sex and Sleep Disruption as Contributing Factors in Alzheimer's Disease. J Alzheimers Dis 2024; 97:31-74. [PMID: 38007653 PMCID: PMC10842753 DOI: 10.3233/jad-230527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
Alzheimer's disease (AD) affects more women than men, with women throughout the menopausal transition potentially being the most under researched and at-risk group. Sleep disruptions, which are an established risk factor for AD, increase in prevalence with normal aging and are exacerbated in women during menopause. Sex differences showing more disrupted sleep patterns and increased AD pathology in women and female animal models have been established in literature, with much emphasis placed on loss of circulating gonadal hormones with age. Interestingly, increases in gonadotropins such as follicle stimulating hormone are emerging to be a major contributor to AD pathogenesis and may also play a role in sleep disruption, perhaps in combination with other lesser studied hormones. Several sleep influencing regions of the brain appear to be affected early in AD progression and some may exhibit sexual dimorphisms that may contribute to increased sleep disruptions in women with age. Additionally, some of the most common sleep disorders, as well as multiple health conditions that impair sleep quality, are more prevalent and more severe in women. These conditions are often comorbid with AD and have bi-directional relationships that contribute synergistically to cognitive decline and neuropathology. The association during aging of increased sleep disruption and sleep disorders, dramatic hormonal changes during and after menopause, and increased AD pathology may be interacting and contributing factors that lead to the increased number of women living with AD.
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Affiliation(s)
- Carrie E. Johnson
- University of Kentucky, College of Medicine, Department of Molecular and Cellular Biochemistry, Lexington, KY, USA
| | - Marilyn J. Duncan
- University of Kentucky, College of Medicine, Department of Neuroscience, Lexington, KY, USA
| | - M. Paul Murphy
- University of Kentucky, College of Medicine, Department of Molecular and Cellular Biochemistry, Lexington, KY, USA
- University of Kentucky, Sanders-Brown Center on Aging, Lexington, KY, USA
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14
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Affiliation(s)
- David R Rubinow
- Departments of Psychiatry and Medicine, School of Medicine, University of North Carolina at Chapel Hill
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15
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Eisenlohr-Moul T, Swales DA, Rubinow DR, Schiff L, Schiller CE. Temporal dynamics of neurobehavioral hormone sensitivity in a scaled-down experimental model of early pregnancy and parturition. Neuropsychopharmacology 2024; 49:414-421. [PMID: 37524753 PMCID: PMC10724266 DOI: 10.1038/s41386-023-01687-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 08/02/2023]
Abstract
The hormonal changes of pregnancy and parturition can trigger robust changes in affective state, particularly among patients with a history of postpartum depression. However, more work is needed to elucidate the temporal dynamics of symptom emergence. The current study explored how quickly hormone-sensitive (HS+) individuals can be differentiated from hormone-insensitive (HS-) controls in the context of a tightly controlled experimental hormone manipulation, and which symptoms demonstrate the most rapid, consistent, and largest response during this protocol. Participants were female, non-pregnant, and euthymic, with a history of DSM-5 major depressive episode with peripartum onset (n = 15) or parous healthy controls with no psychiatric history (n = 15). Perinatal hormonal changes were simulated by inducing hypogonadism, adding back estradiol (E2) and progesterone (P4) to reach first-trimester levels for 8 weeks, and then subsequently withdrawing both hormones. Those reporting a 30% or greater increase during addback or withdrawal on select subscales of the Inventory of Depression and Anxiety Symptoms (IDAS) were identified as HS+. Participants provided daily ratings of symptoms throughout the study via the Daily Record of Severity of Problems. Results indicated that HS+ participants could be differentiated from HS- participants early in the hormone protocol, with many symptoms showing significantly greater change from baseline within the first week of addback. Notably, the most rapid symptom increases were observed for Anger/Irritability, Mood Swings, Overwhelm, Lethargy, Increased Appetite, Joint and Muscle Pain, and Breast Tenderness, reaching 50% of peak group contrast within the first week of hormone addback. The largest group effects were observed for Anger/Irritability, followed by Fatigue and Anxiety, and the most consistent group effects were observed for Anger/Irritability, Interpersonal Conflict, Overwhelm, and Hopelessness. Findings support the role of reproductive hormones in the onset of perinatal affective disorders. The rapid emergence of anger and irritability in HS+ participants suggests that these symptoms may be early indicators of perinatal hormone sensitivity.
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Affiliation(s)
- Tory Eisenlohr-Moul
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, 60612, USA.
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Danielle A Swales
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - David R Rubinow
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Lauren Schiff
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Crystal E Schiller
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
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16
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Patterson R, Balan I, Morrow AL, Meltzer-Brody S. Novel neurosteroid therapeutics for post-partum depression: perspectives on clinical trials, program development, active research, and future directions. Neuropsychopharmacology 2024; 49:67-72. [PMID: 37715106 PMCID: PMC10700474 DOI: 10.1038/s41386-023-01721-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/18/2023] [Accepted: 08/23/2023] [Indexed: 09/17/2023]
Abstract
This article reviews novel neurosteroid therapeutics for post-partum depression, with a focus on their development, clinical trial data, current practices, and future directions in this exciting field. We discuss the clinical impact of brexanolone and several other neurosteroids, particularly as they relate to the treatment of postpartum depression (PPD) and major depressive disorders outside of the perinatal period. There has been increasing interest in GABA signaling and modulation as it pertains to the development of altered circuity and depressive states. This scientific underpinning served as the rationale for the initial development of brexanolone. We review the clinical trials supporting its Food and Drug Administration (FDA) approval as the first rapidly acting antidepressant specific for PPD, and the subsequent development of a clinical brexanolone program at an academic medical center, highlighting new research and data from that site as well as the challenges with the delivery of this I.V. drug. In addition to the GABA signaling hypothesis, we discuss the new evidence demonstrating that brexanolone inhibits inflammatory signaling post-infusion, suggesting that inflammatory signaling may contribute to the etiology of PPD. Finally, we describe new and future directions in neurosteroid therapeutics, including the development of an oral agent, zuranolone, and the IV and oral formulations of ganaxolone. Ultimately, the hope is that these novel neurosteroid therapeutics will provide fast-acting treatment for these impairing disorders and improve our understanding of the underlying mechanisms of depressive disorders.
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Affiliation(s)
- Riah Patterson
- Department of Psychiatry and Emergency Medicine, MacNider Bldg. Suite 304, CB# 7160, Chapel Hill, NC, 27599-7160, USA.
| | - Irina Balan
- Department of Psychiatry, Bowles Center for Alcohol Studies, 3027 Thurston Bowles Building, CB 7178, Chapel Hill, NC, 27599-7178, USA
| | - A Leslie Morrow
- Department of Psychiatry and Pharmacology, Bowles Center for Alcohol Studies, 3027 Thurston Bowles Building, CB 7178, Chapel Hill, NC, 27599-7178, USA
| | - Samantha Meltzer-Brody
- Department of Psychiatry, UNC Center for Women's Mood Disorders, MacNider Bldg. Suite 304CB #7160, Chapel Hill, NC, 27599-7160, USA
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17
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Ko CH, Wong TH, Suen JL, Lin PC, Long CY, Yen JY. Estrogen, progesterone, cortisol, brain-derived neurotrophic factor, and vascular endothelial growth factor during the luteal phase of the menstrual cycle in women with premenstrual dysphoric disorder. J Psychiatr Res 2024; 169:307-317. [PMID: 38070471 DOI: 10.1016/j.jpsychires.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 08/18/2023] [Accepted: 11/15/2023] [Indexed: 01/15/2024]
Abstract
The interplay between ovarian hormones, stress, and inflammatory markers in developing premenstrual dysphoric disorder (PMDD) remains inadequately understood. This study investigated the associations of dynamic changes in the levels of estrogen, progesterone, cortisol, brain-derived neurotrophic factor (BDNF), and vascular endothelial growth factor (VEGF) with PMDD during the luteal phase of the menstrual cycle. A total of 58 women with PMDD and 50 healthy women were recruited in this study. These women's estrogen, progesterone, cortisol, BDNF, and VEGF levels were evaluated during the preovulation (PO), mid-luteal (ML), and late-luteal (LL) phases. Furthermore, the severity of P MDD symptoms, depressive symptoms, perceived stress, inattention, craving for sweet foods, and fatigue was assessed. The findings revealed that women with PMDD with higher levels of progesterone during the ML or LL phase or a greater increase (ML-PO) or higher sum (ML + LL) of luteal progesterone level exhibited a greater increase in PMDD symptoms during the luteal phase than did the healthy controls. Furthermore, women with PMDD exhibited higher cortisol levels during the LL phase than did the controls. The BDNF level was negatively correlated with PMDD severity. Furthermore, BDNF and VEGF levels were negatively correlated with inattention and craving for sweet foods among women with PMDD. These results suggest an association between progesterone and the exacerbation of PMDD symptoms during the LL phase. Women with PMDD have relatively high cortisol levels during the LL phase. Future investigations with experimental designs or larger sample sizes are warranted to verify the roles of progesterone and cortisol in the development of PMDD.
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Affiliation(s)
- Chih-Hung Ko
- Department of Psychiatry, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Tzu-Hsuan Wong
- Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jau-Ling Suen
- Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pai-Cheng Lin
- Department of Psychiatry, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Yu Long
- Department of Gynecology and Obstetrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ju-Yu Yen
- Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Psychiatry, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
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18
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de Jong M, Wynchank DSMR, van Andel E, Beekman ATF, Kooij JJS. Female-specific pharmacotherapy in ADHD: premenstrual adjustment of psychostimulant dosage. Front Psychiatry 2023; 14:1306194. [PMID: 38152361 PMCID: PMC10751335 DOI: 10.3389/fpsyt.2023.1306194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/16/2023] [Indexed: 12/29/2023] Open
Abstract
Objective Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition which is underdiagnosed and undertreated in women. For decades, the ADHD field has called for more insight into female-specific therapy. Preliminary findings postulate that changes in sex hormones during the menstrual cycle may influence the effectiveness of psychostimulant medication. Yet, pharmacotherapeutic interventions tailored to women with ADHD remain scarce. Previously, our group showed an increase in mood symptoms in the premenstrual week in women with ADHD. Premenstrual worsening of depressive and ADHD symptoms represent a treatment challenge. In our adult ADHD clinic, we noted several women describing exacerbation of their ADHD and depressive symptoms in the premenstrual week and/or insufficient effect of their established dosage of psychostimulant. We responded to the need expressed by these women by increasing their stimulant dosage in the premenstrual week, while monitoring the response and side effects. Methods This community case study of nine consecutive women being treated for ADHD and co-occurring conditions (including depression and premenstrual dysphoric disorder), reports our local experience of increasing the individually prescribed psychostimulant dosage during the premenstrual period. We methodically monitored the effect of this increased dosage on ADHD symptoms, mood and somatic symptoms for the following 6-24 months. Results With premenstrual dose elevation, all nine women experienced improved ADHD and mood symptoms with minimal adverse events. Premenstrual inattention, irritability and energy levels improved, and now resembled the other non-premenstrual weeks more closely. All women decided to continue with the elevated premenstrual pharmacotherapy. Discussion Our preliminary results demonstrate potential benefits of increasing premenstrual psychostimulant dosage in women with ADHD, experiencing premenstrual worsening of ADHD and mood symptoms. The results concur with previous findings of diminished response to amphetamines in the late luteal phase. Increased dosage may help combat premenstrual worsening of cognitive and emotional symptoms in women with ADHD, with significant clinical implications. Better management of premenstrual ADHD and mood symptoms in vulnerable women can improve treatment outcome and meet an unmet need. However, implementation should be individually explored. Further investigation of luteal phase psychostimulant dose adjustment is required for safe, optimal and individualised treatment for women with ADHD.
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Affiliation(s)
- M. de Jong
- PsyQ, Expertise Centre Adult ADHD, The Hague, Netherlands
- Department of Psychiatry, Amsterdam UMC/VUmc, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, VU Medical Centre, Amsterdam, Netherlands
| | | | - E. van Andel
- PsyQ, Expertise Centre Adult ADHD, The Hague, Netherlands
| | - A. T. F. Beekman
- Department of Psychiatry, Amsterdam UMC/VUmc, Amsterdam, Netherlands
- GGZ inGeest, Amsterdam, Netherlands
| | - J. J. S. Kooij
- PsyQ, Expertise Centre Adult ADHD, The Hague, Netherlands
- Department of Psychiatry, Amsterdam UMC/VUmc, Amsterdam, Netherlands
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Hou L, Meng Y, Gao J, Li M, Zhou R. Women with more severe premenstrual syndrome have an enhanced anticipatory reward processing: a magnetoencephalography study. Arch Womens Ment Health 2023; 26:803-817. [PMID: 37730923 DOI: 10.1007/s00737-023-01368-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023]
Abstract
Laboratory studies reveal that young women with premenstrual syndrome (PMS) often exhibit decreased reward processing during the late luteal phase. However, studies based on the self-reports find opposite results (e.g., higher craving for high-sweet-fat food). These differences may lie in the difference between the stimulus used and measuring the different aspects of the reward. The present study was designed to expand previous work by using a classic monetary reward paradigm, simultaneously examining the motivational (i.e., reward anticipation, "wanting") and emotional (i.e., reward outcome, "liking") components of reward processing in women with high premenstrual symptoms (High PMS). College female students in their early twenties with High PMS (n = 20) and low premenstrual symptoms (Low PMS, n = 20) completed a monetary incentive delay task during their late luteal phase when the premenstrual symptoms typically peak. Brain activities in the reward anticipation phase and outcome phase were recorded using the magnetoencephalographic (MEG) imaging technique. No group differences were found in various behavioral measurements. For the MEG results, in the anticipation phase, when High PMS participants were presented with cues that predicted the upcoming monetary gains, they showed higher event-related magnetic fields (ERFs) than when they were presented with neutral non-reward cues. This pattern was reversed in Low PMS participants, as they showed lower reward cue-elicited ERFs than non-reward cue-elicited ones (cluster mass = 2560, cluster size = 891, p = .03, corrected for multiple comparisons), mainly in the right medial orbitofrontal and lateral orbitofrontal cortex (cluster mass = 375, cluster size = 140, p = .03, corrected for multiple comparisons). More importantly, women with High PMS had an overall significantly higher level of ERFs than women with Low PMS (cluster mass = 8039, cluster size = 2937, p = .0009, corrected for multiple comparisons) in the bilateral precentral gyrus, right postcentral gyrus, and left superior temporal gyrus (right: cluster mass = 410, cluster size = 128, p = .03; left: cluster mass = 352, cluster size = 98, p = .05; corrected for multiple comparisons). In the outcome phase, women with High PMS showed significantly lower theta power than the Low PMS ones for the expected non-reward feedback in the bilateral temporal-parietal regions (cluster mass = 47620, cluster size = 18308, p = .01, corrected for multiple comparisons). These findings reveal that the severity of PMS might alter reward anticipation. Specifically, women with High PMS displayed increased brain activities to reward-predicting cues and increased action preparation after the cues appear.
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Affiliation(s)
- Lulu Hou
- Department of Psychology, Nanjing University, Nanjing, 210023, China
- Department of Psychology, Shanghai Normal University, Shanghai, 200234, China
| | - Yao Meng
- Department of Psychology, Nanjing University, Nanjing, 210023, China
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Jiahong Gao
- Beijing City Key Lab for Medical Physics and Engineering, Institution of Heavy Ion Physics, School of Physics, Peking University, Beijing, 100871, China
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, 100871, China
- McGovern Institute for Brain Research, Peking University, Beijing, 100871, China
| | - Ming Li
- Department of Psychology, Nanjing University, Nanjing, 210023, China
| | - Renlai Zhou
- Department of Psychology, Nanjing University, Nanjing, 210023, China.
- Department of Radiology, the Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China.
- State Key Laboratory of Media Convergence Production Technology and Systems, Beijing, 100803, China.
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20
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Akyuz Cim EF, Cim N. The Effect of Premenstrual Dysphoric Disorder Diagnosis and Severity on Depression Sensitivity. J Nerv Ment Dis 2023; 211:862-865. [PMID: 37851411 DOI: 10.1097/nmd.0000000000001736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
ABSTRACT Premenstrual dysphoric disorder (PMDD) is thought to be associated with depressive disorder. In our study, the depression susceptibility of female patients with PMDD was assessed using the depression sensitivity scale, which is different from previous studies. The study was conducted on 32 PMDD patients aged 18-40 years who applied to the psychiatry outpatient clinic and 30 healthy controls. The mean age of women diagnosed with PMDD was similar ( p = 0.467). The probability of having a family history of PMDD was significantly higher in the PMDD group than in the control group (χ 2 = 11.182, p = 0.001). Previous psychotropic drug use (χ 2 = 8.862, p = 0.003) and family history of mental illness (χ 2 = 5.995, p = 0.014) were significantly higher in PMDD patients compared with the control group. The sociodemographic questionnaire, the Leiden Index of Depression Sensitivity (LEIDS), and the Premenstrual Assessment Form were administered to the participants. No significant difference was found between the patient and healthy groups regarding LEIDS scores ( r = 0.75, p > 0.05). In patients with PMDD, the clinical severity of PMDD was found to increase susceptibility to depression ( r = 0.460, p < 0.01). It was revealed that PMDD severity was associated with susceptibility to depression rather than PMDD diagnosis.
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Affiliation(s)
- Emine Fusun Akyuz Cim
- Department of Psychiatry, Florence Nightingale Hospital, Medical Faculty, Demiroglu Bilim University, Istanbul, Turkey
| | - Numan Cim
- Department of Gynecology and Obstetrics, Haseki Training and Research Hospital, Istanbul, Turkey
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Barone JC, Butler MP, Ross A, Patterson A, Wagner-Schuman M, Eisenlohr-Moul TA. A scoping review of hormonal clinical trials in menstrual cycle-related brain disorders: Studies in premenstrual mood disorder, menstrual migraine, and catamenial epilepsy. Front Neuroendocrinol 2023; 71:101098. [PMID: 37619655 PMCID: PMC10843388 DOI: 10.1016/j.yfrne.2023.101098] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 08/17/2023] [Accepted: 08/19/2023] [Indexed: 08/26/2023]
Abstract
Cyclic variations in hormones during the normal menstrual cycle underlie multiple central nervous system (CNS)-linked disorders, including premenstrual mood disorder (PMD), menstrual migraine (MM), and catamenial epilepsy (CE). Despite this foundational mechanistic link, these three fields operate independently of each other. In this scoping review (N = 85 studies), we survey existing human research studies in PMD, MM, and CE to outline the exogenous experimental hormone manipulation trials conducted in these fields. We examine a broad range of literature across these disorders in order to summarize existing diagnostic practices and research methods, highlight gaps in the experimental human literature, and elucidate future research opportunities within each field. While no individual treatment or study design can fit every disease, there is immense overlap in study design and established neuroendocrine-based hormone sensitivity among the menstrual cycle-related disorders PMD, MM, and CE. SCOPING REVIEW STRUCTURED SUMMARY Background. The menstrual cycle can be a biological trigger of symptoms in certain brain disorders, leading to specific, menstrual cycle-linked phenomena such as premenstrual mood disorders (PMD), menstrual migraine (MM), and catamenial epilepsy (CE). Despite the overlap in chronicity and hormonal provocation, these fields have historically operated independently, without any systematic communication about methods or mechanisms. OBJECTIVE Online databases were used to identify articles published between 1950 and 2021 that studied hormonal manipulations in reproductive-aged females with either PMD, MM, or CE. We selected N = 85 studies that met the following criteria: 1) included a study population of females with natural menstrual cycles (e.g., not perimenopausal, pregnant, or using hormonal medications that were not the primary study variable); 2) involved an exogenous hormone manipulation; 3) involved a repeated measurement across at least two cycle phases as the primary outcome variable. CHARTING METHODS After exporting online database query results, authors extracted sample size, clinical diagnosis of sample population, study design, experimental hormone manipulation, cyclical outcome measure, and results from each trial. Charting was completed manually, with two authors reviewing each trial. RESULTS Exogenous hormone manipulations have been tested as treatment options for PMD (N = 56 trials) more frequently than MM (N = 21) or CE (N = 8). Combined oral contraceptive (COC) trials, specifically those containing drospirenone as the progestin, are a well-studied area with promising results for treating both PMDD and MM. We found no trials of COCs in CE. Many trials test ovulation suppression using gonadotropin-releasing hormone agonists (GnRHa), and a meta-analysis supports their efficacy in PMD; GnRHa have been tested in two MM-related trials, and one CE open-label case series. Finally, we found that non-contraceptive hormone manipulations, including but not limited to short-term transdermal estradiol, progesterone supplementation, and progesterone antagonism, have been used across all three disorders. CONCLUSIONS Research in PMD, MM, and CE commonly have overlapping study design and research methods, and similar effects of some interventions suggest the possibility of overlapping mechanisms contributing to their cyclical symptom presentation. Our scoping review is the first to summarize existing clinical trials in these three brain disorders, specifically focusing on hormonal treatment trials. We find that PMD has a stronger body of literature for ovulation-suppressing COC and GnRHa trials; the field of MM consists of extensive estrogen-based studies; and current consensus in CE focuses on progesterone supplementation during the luteal phase, with limited estrogen manipulations due to concerns about seizure provocation. We argue that researchers in any of these respective disciplines would benefit from greater communication regarding methods for assessment, diagnosis, subtyping, and experimental manipulation. With this scoping review, we hope to increase collaboration and communication among researchers to ultimately improve diagnosis and treatment for menstrual-cycle-linked brain disorders.
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Affiliation(s)
- Jordan C Barone
- University of Illinois at Chicago, Department of Psychiatry, USA; University of Illinois at Chicago, Medical Scientist Training Program, USA.
| | - Mitchell P Butler
- University of Illinois at Chicago, Medical Scientist Training Program, USA; University of Illinois at Chicago, Department of Neurology and Rehabilitation, USA
| | - Ashley Ross
- University of Illinois at Chicago, Department of Psychiatry, USA; University of Illinois at Chicago, Medical Scientist Training Program, USA
| | - Anna Patterson
- University of Illinois at Chicago, Department of Psychiatry, USA; University of Illinois at Chicago, Medical Scientist Training Program, USA
| | | | - Tory A Eisenlohr-Moul
- University of Illinois at Chicago, Department of Psychiatry, USA; University of Illinois at Chicago, Medical Scientist Training Program, USA
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22
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Sikes-Keilp C, Rubinow DR. GABA-ergic Modulators: New Therapeutic Approaches to Premenstrual Dysphoric Disorder. CNS Drugs 2023; 37:679-693. [PMID: 37542704 DOI: 10.1007/s40263-023-01030-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/07/2023]
Abstract
Premenstrual dysphoric disorder (PMDD) is characterized by the predictable onset of mood and physical symptoms secondary to gonadal steroid fluctuation during the luteal phase of the menstrual cycle. Although menstrual-related affective dysfunction is responsible for considerable functional impairment and reduction in quality of life worldwide, currently approved treatments for PMDD are suboptimal in their effectiveness. Research over the past two decades has suggested that the interaction between allopregnanolone, a neurosteroid derivative of progesterone, and the gamma-aminobutyric acid (GABA) system represents an important relationship underlying symptom genesis in reproductive-related mood disorders, including PMDD. The objective of this narrative review is to discuss the plausible link between changes in GABAergic transmission secondary to the fluctuation of allopregnanolone during the luteal phase and mood impairment in susceptible individuals. As part of this discussion, we explore promising findings from early clinical trials of several compounds that stabilize allopregnanolone signaling during the luteal phase, including dutasteride, a 5-alpha reductase inhibitor; isoallopregnanolone, a GABA-A modulating steroid antagonist; and ulipristal acetate, a selective progesterone receptor modulator. We then reflect on the implications of these therapeutic advances, including how they may promote our knowledge of affective regulation more generally. We conclude that these and other studies of PMDD may yield critical insight into the etiopathogenesis of affective disorders, considering that (1) symptoms in PMDD have a predictable onset and offset, allowing for examination of affective state kinetics, and (2) GABAergic interventions in PMDD can be used to better understand the relationship between mood states, network regulation, and the balance between excitatory and inhibitory signaling in the brain.
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Affiliation(s)
- Christopher Sikes-Keilp
- Department of Psychiatry, University of North Carolina Hospitals, 101 Manning Drive, Chapel Hill, NC, 27514, USA.
| | - David R Rubinow
- Department of Psychiatry, University of North Carolina Hospitals, 101 Manning Drive, Chapel Hill, NC, 27514, USA
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23
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Bäckström T, Bengtsson SKS, Sjöstedt J, Malinina E, Johansson M, Ragagnin G, Ekberg K, Lundgren P. Isoallopregnanolone Inhibits Estrus Cycle-Dependent Aggressive Behavior. Biomolecules 2023; 13:1017. [PMID: 37371597 DOI: 10.3390/biom13061017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/11/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
Among female rats, some individuals show estrus cycle-dependent irritability/aggressive behaviors, and these individual rats may be used as a model for premenstrual dysphoric disorder (PMDD). We wanted to investigate if these behaviors are related to the estrus cycle phase containing moderately increased levels of positive GABA-A receptor-modulating steroids (steroid-PAM), especially allopregnanolone (ALLO), and if the adverse behavior can be antagonized. The electrophysiology studies in this paper show that isoallopregnanolone (ISO) is a GABA-A-modulating steroid antagonist (GAMSA), meaning that ISO can antagonize the agonistic effects of positive GABA-A receptor-modulating steroids in both α1β2γ2L and α4β3δ GABA-A receptor subtypes. In this study, we also investigated whether ISO could antagonize the estrus cycle-dependent aggressive behaviors in female Wistar rats using a resident-intruder test. Our results confirmed previous reports of estrus cycle-dependent behaviors in that 42% of the tested rats showed higher levels of irritability/aggression at diestrus compared to those at estrus. Furthermore, we found that, during the treatment with ISO, the aggressive behavior at diestrus was alleviated to a level comparable to that of estrus. We noticed an 89% reduction in the increase in aggressive behavior at diestrus compared to that at estrus. Vehicle treatment in the same animals showed a minimal effect on the diestrus-related aggressive behavior. In conclusion, we showed that ISO can antagonize Steroid-PAM both in α1β2γ2L and α4β3δ GABA-A receptor subtypes and inhibit estrus cycle-dependent aggressive behavior.
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Affiliation(s)
- Torbjörn Bäckström
- Umeå Neurosteroid Research Center, Department of Clinical Science, Umeå University, SE-901 85 Umea, Sweden
| | - Sara K S Bengtsson
- Umeå Neurosteroid Research Center, Department of Clinical Science, Umeå University, SE-901 85 Umea, Sweden
| | - Jessica Sjöstedt
- Umeå Neurosteroid Research Center, Department of Clinical Science, Umeå University, SE-901 85 Umea, Sweden
| | - Evgenya Malinina
- Umeå Neurosteroid Research Center, Department of Clinical Science, Umeå University, SE-901 85 Umea, Sweden
| | - Maja Johansson
- Umeå Neurosteroid Research Center, Department of Clinical Science, Umeå University, SE-901 85 Umea, Sweden
| | - Gianna Ragagnin
- Umeå Neurosteroid Research Center, Department of Clinical Science, Umeå University, SE-901 85 Umea, Sweden
| | - Karin Ekberg
- Asarina Pharma AB, Fogdevreten 2, SE-171 65 Solna, Sweden
| | - Per Lundgren
- Umeå Neurosteroid Research Center, Department of Clinical Science, Umeå University, SE-901 85 Umea, Sweden
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24
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Hantsoo L, Payne JL. Towards understanding the biology of premenstrual dysphoric disorder: From genes to GABA. Neurosci Biobehav Rev 2023; 149:105168. [PMID: 37059403 PMCID: PMC10176022 DOI: 10.1016/j.neubiorev.2023.105168] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/10/2023] [Accepted: 04/10/2023] [Indexed: 04/16/2023]
Abstract
Premenstrual dysphoric disorder (PMDD) is a severe mood disorder, with affective symptoms that rise and fall in concert with the hormonal fluctuations of the menstrual cycle. PMDD's pathophysiology is poorly understood. This review describes recent research on potential biological contributors to PMDD, with a focus on neuroactive steroids, genetics, neuroimaging and cellular studies. Studies suggest that a key contributor is abnormal central nervous system (CNS) response to fluctuations in neuroactive steroid hormones. Imaging studies are limited but support alterations in serotonergic and GABA transmission. Genetic studies suggest heritability, yet specific genetic contributors have not been characterized. Finally, recent cutting-edge cellular studies indicate an underlying vulnerability to the effect of sex hormones at a cellular level. Overall the findings across studies do not yet fit together into a complete description of the underlying biology of PMDD. It is possible that PMDD consists of biological subtypes, and future research may benefit from a subtyping approach.
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Affiliation(s)
- Liisa Hantsoo
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, 550 N. Broadway Street, Baltimore, MD 21205, USA.
| | - Jennifer L Payne
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, PO Box 800548, Charlottesville, VA 22908, USA
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25
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Sundström-Poromaa I, Comasco E. New Pharmacological Approaches to the Management of Premenstrual Dysphoric Disorder. CNS Drugs 2023; 37:371-379. [PMID: 37171547 DOI: 10.1007/s40263-023-01004-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 05/13/2023]
Abstract
Premenstrual symptoms are experienced by many female individuals during their fertile age. Premenstrual dysphoric disorder (PMDD), a sex-specific mood disorder, affects about 5% of female individuals during the luteal phase of the menstrual cycle. Treatment with selective serotonin reuptake inhibitors represents a valid solution to manage PMDD for many, but not all, patients. Owing to maladaptive neural reactivity to gonadal hormone fluctuations, that is, the putative mechanism postulated to underlie PMDD, drugs suppressing or stabilizing such variations have been tested. Recently, a clinically significant reduction in the severity of the mental symptoms of PMDD was observed upon treatment with a selective progesterone receptor modulator (SPRM), as demonstrated when comparing ulipristal acetate with placebo in a randomised controlled trial. Stable and low progesterone levels, with maintained low-medium oestradiol levels, define the endocrine profile of this treatment. Importantly, the efficacy of SPRM treatment was accompanied by negligible side effects. These promising results represent a headway to understanding the mechanisms behind PMDD symptomatology and opening up new solutions in the management of PMDD. They also call for studies on the long-term efficacy, safety, and viability of SPRMs in female individuals during their fertile age to further support the development of targeted management of female's mental ill-health in relation to the menstrual cycle. The present overview thus seeks to inform about current and new pharmacological approaches to the management of premenstrual dysphoric disorder.
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Affiliation(s)
| | - Erika Comasco
- Department of Women's and Children's Health, Science for Life Laboratory, Uppsala University BMC, POB 593, 75124, Uppsala, Sweden.
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Stiernman L, Dubol M, Comasco E, Sundström-Poromaa I, Boraxbekk CJ, Johansson M, Bixo M. Emotion-induced brain activation across the menstrual cycle in individuals with premenstrual dysphoric disorder and associations to serum levels of progesterone-derived neurosteroids. Transl Psychiatry 2023; 13:124. [PMID: 37055419 PMCID: PMC10101953 DOI: 10.1038/s41398-023-02424-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/23/2023] [Accepted: 03/29/2023] [Indexed: 04/15/2023] Open
Abstract
Premenstrual dysphoric disorder (PMDD) is a debilitating disorder characterized by severe mood symptoms in the luteal phase of the menstrual cycle. PMDD symptoms are hypothesized to be linked to an altered sensitivity to normal luteal phase levels of allopregnanolone (ALLO), a GABAA-modulating progesterone metabolite. Moreover, the endogenous 3β-epimer of ALLO, isoallopregnanolone (ISO), has been shown to alleviate PMDD symptoms through its selective and dose-dependent antagonism of the ALLO effect. There is preliminary evidence showing altered recruitment of brain regions during emotion processing in PMDD, but whether this is associated to serum levels of ALLO, ISO or their relative concentration is unknown. In the present study, subjects with PMDD and asymptomatic controls underwent functional magnetic resonance imaging (fMRI) in the mid-follicular and the late-luteal phase of the menstrual cycle. Brain responses to emotional stimuli were investigated and related to serum levels of ovarian steroids, the neurosteroids ALLO, ISO, and their ratio ISO/ALLO. Participants with PMDD exhibited greater activity in brain regions which are part of emotion-processing networks during the late-luteal phase of the menstrual cycle. Furthermore, activity in key regions of emotion processing networks - the parahippocampal gyrus and amygdala - was differentially associated to the ratio of ISO/ALLO levels in PMDD subjects and controls. Specifically, a positive relationship between ISO/ALLO levels and brain activity was found in PMDD subjects, while the opposite was observed in controls. In conclusion, individuals with PMDD show altered emotion-induced brain responses in the late-luteal phase of the menstrual cycle which may be related to an abnormal response to physiological levels of GABAA-active neurosteroids.
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Affiliation(s)
| | - Manon Dubol
- Department of Women's and Children's Health, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Erika Comasco
- Department of Women's and Children's Health, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | | | - Carl-Johan Boraxbekk
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden
- Institute for Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
- Umeå Center for Functional Brain Imaging (UFBI), Umeå University, Umeå, Sweden
- Institute of Sports Medicine Copenhagen (ISMC) and Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Maja Johansson
- Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Marie Bixo
- Department of Clinical Sciences, Umeå University, Umeå, Sweden.
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Zehravi M, Maqbool M, Ara I. Unfolding the mystery of premenstrual syndrome (PMS): an overview. Int J Adolesc Med Health 2023; 35:9-13. [PMID: 36117244 DOI: 10.1515/ijamh-2022-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/12/2022] [Indexed: 11/15/2022]
Abstract
Physical, emotional, and psychological symptoms are common among women in their reproductive years, particularly during their menstrual cycle's luteal phase and the week before their period. Approximately 5-8 percent of women suffer with premenstrual syndrome, with the majority of those suffering from premenstrual dysphoric disorder (PMDD). Because of the complexity and multifaceted nature of the aetiology, it is yet unknown. Premenstrual syndrome (PMS) is diagnosed entirely on the basis of signs and symptoms, with no particular diagnostic tests available to confirm the diagnosis. Only a small number of therapeutic modalities are backed by clinical data, yet there are many accessible. After providing a brief overview of the disease, the author goes on to discuss the various hypotheses as to why PMS occurs. With an emphasis on tailored treatment based on symptom profile, it examines the wide range of non-pharmacological and pharmaceutical methods that are accessible today.
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Affiliation(s)
- Mehrukh Zehravi
- Department of Clinical Pharmacy Girls Section, Prince Sattam Bin Abdul Aziz University, Alkharj, Saudia Arabia
| | - Mudasir Maqbool
- Department of Pharmaceutical Sciences, University of Kashmir, Srinagar, Jammu and Kashmir, India
| | - Irfat Ara
- Regional Research Institute of Unani Medicine, Srinagar, Jammu and Kashmir, India
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28
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Takeda T. Premenstrual disorders: Premenstrual syndrome and premenstrual dysphoric disorder. J Obstet Gynaecol Res 2023; 49:510-518. [PMID: 36317488 DOI: 10.1111/jog.15484] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 10/20/2022] [Indexed: 02/10/2023]
Abstract
Recently, the term premenstrual disorders (PMDs), which includes premenstrual syndrome and premenstrual dysphoric disorder as a continuum, has been proposed. Although the precise etiology of PMDs remains unknown, the involvement of hormonal fluctuations is clear. The brain transmitters, serotonin and γ-amino butyric acid, also seem to be involved. Serotonin reuptake inhibitors and oral contraceptives are the current mainstay of treatment, but these are insufficient. Even the currently used prospective two-period symptom diary is not widely used in actual clinical practice, creating a major problem of discrepancy between research and clinical practice. In this review, I would like to outline the latest information and problems in the etiology, diagnosis, and treatment of PMDs, with an emphasis on promising new therapies.
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Affiliation(s)
- Takashi Takeda
- Division of Women's Health, Research Institute of Traditional Asian Medicine, Kindai University School of Medicine, Osaka, Japan
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29
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Quaglia C, Nettore IC, Palatucci G, Franchini F, Ungaro P, Colao A, Macchia PE. Association between Dietary Habits and Severity of Symptoms in Premenstrual Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1717. [PMID: 36767083 PMCID: PMC9914022 DOI: 10.3390/ijerph20031717] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Premenstrual syndrome (PMS) is a set of physical, psychological, and emotional symptoms that occur during the luteal phase of the menstrual cycle. The etiopathogenesis of this condition is not fully understood, and several studies suggest a possible role of environmental factors, such as diet. The aim of this work was to investigate the relationship between dietary habits and the occurrence and severity of PMS. METHODS AND RESULTS Forty-seven women were enrolled in the study. Participants were asked to complete the Daily Record of Severity of Problems (DRSP) to diagnose PMS and to complete a three-day food record during the perimenstrual phase. Thirty women completed the study (16 with PMS and 14 controls). An analysis of the food diaries revealed no differences between the women with PMS and the control subjects in terms of total energy intake (1649 vs. 1570 kcal/day), diet composition, and the consumption of macro- or micronutrients, except for copper, whose consumption was higher in women with PMS than in the control subjects (1.27 ± 0.51 vs. 0.94 ± 0.49 mg/d, p < 0.05). CONCLUSIONS The data presented here are very preliminary, and only a significant difference in copper intake was found when comparing women with PMS and controls. Larger studies are needed to better define how diet may contribute to the exacerbation of the psychological and somatic symptoms associated with PMS and whether PMS itself may influence macro- or micronutrient intake by changing dietary habits.
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Affiliation(s)
- Cinzia Quaglia
- Dipartimento di Medicina Clinica e Chirurgia, Scuola di Medicina e Chirurgia, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Immacolata Cristina Nettore
- Dipartimento di Medicina Clinica e Chirurgia, Scuola di Medicina e Chirurgia, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Giuseppe Palatucci
- Dipartimento di Medicina Clinica e Chirurgia, Scuola di Medicina e Chirurgia, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Fabiana Franchini
- Dipartimento di Medicina Clinica e Chirurgia, Scuola di Medicina e Chirurgia, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Paola Ungaro
- Istituto per l’Endocrinologia e l’Oncologia Sperimentale (IEOS) “Gaetano Salvatore”, Consiglio Nazionale delle Ricerche, 80131 Naples, Italy
- UNESCO Chair on Health Education and Sustainable Development, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Scuola di Medicina e Chirurgia, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
- UNESCO Chair on Health Education and Sustainable Development, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Paolo Emidio Macchia
- Dipartimento di Medicina Clinica e Chirurgia, Scuola di Medicina e Chirurgia, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
- UNESCO Chair on Health Education and Sustainable Development, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
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30
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Barone JC, Ross JM, Nagpal A, Guzman G, Berenz E, Pang RD, Eisenlohr-Moul TA. Alcohol use and motives for drinking across the menstrual cycle in a psychiatric outpatient sample. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:127-142. [PMID: 36661851 PMCID: PMC9975029 DOI: 10.1111/acer.14971] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 09/27/2022] [Accepted: 11/01/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Females who misuse alcohol experience high rates of negative physical and mental health consequences. Existing findings are inconsistent but suggest a relationship between ovarian hormones and alcohol use. We aim to clarify how alcohol use and drinking motives vary across the menstrual cycle in female psychiatric outpatients using the luteinizing hormone (LH)-confirmed cycle phase. METHODS Daily self-reports (n = 3721) were collected from 94 naturally cycling females, recruited for past-month suicidal ideation, during the baseline phase of three parent clinical trials between February 2017 and May 2022. Multilevel logistic and linear models estimated the relationship between the cycle phase (with LH-surge confirmed ovulation) and daily alcohol use or drinking motives, moderated by the weekend. Models were adjusted for age, legal drinking status, substance use disorder, and the COVID-19 pandemic, and included random effects. RESULTS Participants were generally more likely to drink in the midluteal (vs. perimenstrual) phase, but more likely to drink heavily on weekends in periovulatory and perimenstrual (vs. midluteal) phases. Social motives for drinking were significantly higher on weekends in the periovulatory, mid-follicular, and midluteal phases (vs. weekdays), but this finding was non-significant in the perimenstrual phase. Participants rated drinking to cope higher in the perimenstrual phase (vs. midluteal phase), regardless of the weekend. CONCLUSION In a psychiatric sample with LH-surge-confirmed ovulation, we find an increased likelihood to drink heavily in periovulatory and perimenstrual phases on weekends. We also find that the perimenstrual phase is associated with increased drinking to cope, and relatively lower weekend social drinking. Finally, random effects across models suggest individual differences in the extent to which the cycle influences drinking. Our findings stress (1) predictable phases of increased high-risk alcohol use across the menstrual cycle, and (2) the importance of individual assessment of cyclical changes in alcohol use to predict and prevent ovulation- and menses-related surges in heavy drinking.
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Affiliation(s)
- Jordan C Barone
- Department of Psychiatry, University of Illinois at Chicago, Illinois, Chicago, USA
- Graduate Program in Neuroscience, University of Illinois at Chicago, Illinois, Chicago, USA
| | - Jaclyn M Ross
- Department of Psychiatry, University of Illinois at Chicago, Illinois, Chicago, USA
| | - Anisha Nagpal
- Department of Psychiatry, University of Illinois at Chicago, Illinois, Chicago, USA
- Graduate Program in Neuroscience, University of Illinois at Chicago, Illinois, Chicago, USA
| | - Gabriela Guzman
- Department of Psychiatry, University of Illinois at Chicago, Illinois, Chicago, USA
| | - Erin Berenz
- Department of Psychology, University of Illinois at Chicago, Illinois, Chicago, USA
| | - Raina D Pang
- Department of Population and Public Health Sciences & Psychology, University of Southern California, California, Los Angeles, USA
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31
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Ciccone N, Kovacheff MB, Frey BN. The pharmacotherapeutic management of premenstrual dysphoric disorder. Expert Opin Pharmacother 2023; 24:145-151. [PMID: 35974667 DOI: 10.1080/14656566.2022.2114345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Premenstrual dysphoric disorder (PMDD) is a prevalent psychiatric condition associated with substantial mental distress, impaired psychosocial functioning, high rates of co-morbid psychiatric conditions, and elevated risk of suicide. AREAS COVERED We provide an update on epidemiology, pathophysiology, clinical presentation, and diagnosis of PMDD, with a focus on the pharmacological management of this condition. EXPERT OPINION Given the high rates of false positives from retrospective assessments, prospective daily symptom monitoring for a minimal of two symptomatic menstrual cycles is critical to accurately confirm (or rule out) the diagnosis of PMDD. Serotonin-based antidepressants are well-established first-line treatments of PMDD. Second-line treatment includes the use of combined, monophasic oral contraceptives. In mild to moderate cases, independent meta-analyses have shown efficacy of Chasteberry extract (Vitex agnus cactus). Preliminary results with compounds blocking the synthesis of allopregnanolone are promising.
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Affiliation(s)
- Nancy Ciccone
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Maya B Kovacheff
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Benicio N Frey
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Hou L, Chen L, Zhang W. The longitudinal predictive effect of self-reported frequency of premenstrual syndrome on depression: Findings from the Australian Longitudinal Study on Women's Health. Front Public Health 2023; 11:1126190. [PMID: 37033080 PMCID: PMC10076728 DOI: 10.3389/fpubh.2023.1126190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Background Previous studies have revealed a high comorbidity between premenstrual syndrome (PMS) and depression; however, whether PMS can longitudinally predict depression has not been examined in large sample studies. Methods This study surveyed 8,133 women from the 1973-78 cohort of the Australian Longitudinal Study on Women's Health. Participants completed seven repeated measurements at 3-year intervals starting in 2000 (aged 22-27 years). Binary logistic and multivariate ordered logistic regression models were used to examine the predictive role of self-reported frequency of PMS symptoms in 2000 on self-reported diagnosis of depression and frequency of depressive symptoms, respectively, for each follow-up survey. Results Self-reported frequency of PMS symptoms in the year 2000 predicted self-reported diagnosis of depression in most follow-up surveys. Specifically, compared to women who reported "never" had PMS symptoms in 2000, those who reported "often" had them were more likely to report a diagnosis of depression in 2006 (OR = 1.72), 2012 (OR = 1.88), 2015 (OR = 1.49), and 2018 (OR = 1.90); and those who reported "sometimes" had PMS symptoms in 2000 were more likely to report a diagnosis of depression in 2012 (OR =1.37) and 2018 (OR = 1.59). Furthermore, self-reported frequency of PMS symptoms in 2000 predicted self-reported frequency of depressive symptoms in each follow-up survey. Compared to women who reported "never" had PMS symptoms in 2000, those who reported "sometimes", or "often", had PMS symptoms reported depressive symptoms more frequently. Conclusion Self-reported frequency of PMS can predict the self-reported frequency of depressive symptoms and the subsequent diagnosis of depression.
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Affiliation(s)
- Lulu Hou
- Department of Psychology, Shanghai Normal University, Shanghai, China
| | - Lele Chen
- School of Education Science, Nantong University, Nantong, China
| | - Wenpei Zhang
- Department of Business Administration, School of Business, Anhui University of Technology, Maanshan, China
- *Correspondence: Wenpei Zhang
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Sacher J, Zsido RG, Barth C, Zientek F, Rullmann M, Luthardt J, Patt M, Becker GA, Rusjan P, Witte AV, Regenthal R, Koushik A, Kratzsch J, Decker B, Jogschies P, Villringer A, Hesse S, Sabri O. Increase in serotonin transporter binding in patients with premenstrual dysphoric disorder across the menstrual cycle: a case-control longitudinal neuroreceptor ligand PET imaging study. Biol Psychiatry 2023:S0006-3223(23)00005-7. [PMID: 36997451 DOI: 10.1016/j.biopsych.2022.12.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/30/2022] [Accepted: 12/30/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Premenstrual dysphoric disorder (PMDD) disrupts the lives of millions of people each month. The timing of symptoms suggests that hormonal fluctuations play a role in the pathogenesis. Here, we tested whether a heightened sensitivity of the serotonin system to menstrual cycle phase underlies PMDD, assessing the relationship of serotonin transporter (5-HTT) changes with symptom severity across the menstrual cycle. METHODS In this longitudinal case-control study, we acquired 118 [11C]DASB positron emission tomography scans measuring 5-HTT nondisplaceable binding potential (BPND) in 30 patients with PMDD and 29 controls during 2 menstrual cycle phases (periovulatory, premenstrual). The primary outcome was midbrain and prefrontal cortex 5-HTT BPND. We tested whether BPND changes correlated with depressed mood. RESULTS Linear mixed effects modeling (significant group × time × region interaction) showed a mean increase of 18% in midbrain 5-HTT BPND (mean [SD] periovulatory = 1.64 [0.40], premenstrual = 1.93 [0.40], delta = 0.29 [0.47]: t29 = -3.43, p = .0002) in patients with PMDD, whereas controls displayed a mean 10% decrease in midbrain 5-HTT BPND (periovulatory = 1.65 [0.24] > premenstrual = 1.49 [0.41], delta = -0.17 [0.33]: t28 = -2.73, p = .01). In patients, increased midbrain 5-HTT BPND correlated with depressive symptom severity (R2 = 0.41, p < .0015) across the menstrual cycle. CONCLUSIONS These data suggest cycle-specific dynamics with increased central serotonergic uptake followed by extracellular serotonin loss underlying the premenstrual onset of depressed mood in patients with PMDD. These neurochemical findings argue for systematic testing of pre-symptom-onset dosing of selective serotonin reuptake inhibitors or nonpharmacological strategies to augment extracellular serotonin in people with PMDD.
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Hanna Mossad Samaan M, Mohamed Ahmed Sarhan T, Abd El Azim Ammar R, Hanafy Mahmoud T, Mohamed Ahmed El Shafie A. A study of menstrual cycle effects on pain perception, haemodynamic response to laryngoscopy, and postoperative outcome in gynaecological laparoscopy. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2147472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Mariam Hanna Mossad Samaan
- Assistant Lecturer in Anaesthesia and Surgical Intensive Care, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Tarek Mohamed Ahmed Sarhan
- Assistant Lecturer in Anaesthesia and Surgical Intensive Care, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Ramadan Abd El Azim Ammar
- Assistant Lecturer in Anaesthesia and Surgical Intensive Care, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Tamer Hanafy Mahmoud
- Professor of Obstetrics and Gynaecology, Alexandria Faculty of Medicine, Alexandria, Egypt
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Eisenlohr-Moul TA, Bowers SM, Prinstein MJ, Schmalenberger KM, Walsh EC, Young SL, Rubinow DR, Girdler SS. Effects of acute estradiol and progesterone on perimenstrual exacerbation of suicidal ideation and related symptoms: a crossover randomized controlled trial. Transl Psychiatry 2022; 12:528. [PMID: 36585408 PMCID: PMC9803670 DOI: 10.1038/s41398-022-02294-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/13/2022] [Accepted: 12/16/2022] [Indexed: 12/31/2022] Open
Abstract
Female suicide attempts peak peri-menstrually-around the onset of menses-when the ovarian steroids estradiol (E2) and progesterone (P4) fall rapidly. Given preclinical evidence that withdrawal from either E2 or P4 can provoke behaviors consistent with elevated suicide risk, we hypothesized that withdrawal from one or both of these steroids contributes to perimenstrual exacerbation of suicidal ideation (SI) and related symptoms. In a randomized, controlled, double-blind crossover experiment (NCT03720847), a transdiagnostic sample of naturally cycling, medically healthy psychiatric outpatients reporting past-month SI completed two conditions during two different 14-day experimental intervals (days 7-20 where the luteinizing hormone surge = day 0), separated by a monthlong washout cycle. In the E2 and P4 (EP) condition, participants received transdermal E2 (0.1 mg/day) plus oral micronized P4 (200 mg/day as 100 mg twice daily) to buffer perimenstrual steroid withdrawal. A matched placebo (PBO) condition allowed natural perimenstrual steroid withdrawal. Participants reported daily SI and planning (primary outcomes) and indices of depression (low mood, hopelessness), threat sensitivity (anxiety, perceived stress), executive functioning (difficulty concentrating, impulsivity), and social cognitive bias (rejection sensitivity, perceived burdensomeness). In baseline cycles, no participant met prospective criteria for DSM-5 premenstrual dysphoric disorder, but 59% met all criteria except full follicular symptom remission, and 93% showed the highest SI in the perimenstrual phase. Of 29 randomized, 28 were analyzed (14 EP-PBO, 14 PBO-EP). Experimental administration of E2 and P4 (relative to PBO) reduced perimenstrual exacerbation of SI, suicide planning, depression, hopelessness, perceived stress, rejection sensitivity, and perceived burdensomeness, particularly in the perimenstrual (natural E2 and P4 withdrawal) days. Further, delayed withdrawal from experimental E2 and P4 (but not PBO) recapitulated SI, hopelessness, and rejection sensitivity. Acute perimenstrual withdrawal from ovarian steroids may play a causal role in perimenstrual worsening of depression and SI.
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Affiliation(s)
- Tory A Eisenlohr-Moul
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Psychiatry, The University of Illinois Chicago, Chicago, IL, USA.
| | - Savannah M Bowers
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mitchell J Prinstein
- Department of Psychology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katja M Schmalenberger
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Institute for Medical Psychology, Heidelberg University Hospital, Heidelberg, Germany
| | - Erin C Walsh
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Steven L Young
- Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David R Rubinow
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Susan S Girdler
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Altered visual cortex excitability in premenstrual dysphoric disorder: Evidence from magnetoencephalographic gamma oscillations and perceptual suppression. PLoS One 2022; 17:e0279868. [PMID: 36584199 PMCID: PMC9803314 DOI: 10.1371/journal.pone.0279868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022] Open
Abstract
Premenstrual dysphoric disorder (PMDD) is a psychiatric condition characterized by extreme mood shifts during the luteal phase of the menstrual cycle (MC) due to abnormal sensitivity to neurosteroids and unbalanced neural excitation/inhibition (E/I) ratio. We hypothesized that in women with PMDD in the luteal phase, these factors would alter the frequency of magnetoencephalographic visual gamma oscillations, affect modulation of their power by excitatory drive, and decrease perceptual spatial suppression. Women with PMDD and control women were examined twice-during the follicular and luteal phases of their MC. We recorded visual gamma response (GR) while modulating the excitatory drive by increasing the drift rate of the high-contrast grating (static, 'slow', 'medium', and 'fast'). Contrary to our expectations, GR frequency was not affected in women with PMDD in either phase of the MC. GR power suppression, which is normally associated with a switch from the 'optimal' for GR slow drift rate to the medium drift rate, was reduced in women with PMDD and was the only GR parameter that distinguished them from control participants specifically in the luteal phase and predicted severity of their premenstrual symptoms. Over and above the atypical luteal GR suppression, in both phases of the MC women with PMDD had abnormally strong GR facilitation caused by a switch from the 'suboptimal' static to the 'optimal' slow drift rate. Perceptual spatial suppression did not differ between the groups but decreased from the follicular to the luteal phase only in PMDD women. The atypical modulation of GR power suggests that neuronal excitability in the visual cortex is constitutively elevated in PMDD and that this E/I imbalance is further exacerbated during the luteal phase. However, the unaltered GR frequency does not support the hypothesis of inhibitory neuron dysfunction in PMDD.
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Prevalence and risk factors for depressive and anxiety symptoms in middle-aged Chinese women: a community-based cross-sectional study. BMC Womens Health 2022; 22:319. [PMID: 35906641 PMCID: PMC9338469 DOI: 10.1186/s12905-022-01908-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 07/25/2022] [Indexed: 11/29/2022] Open
Abstract
Background Depression and anxiety have become main public health concerns globally. However, risk factors for depression and anxiety remain unclear. This study was to examine the prevalence and risk factors of depressive and anxiety symptoms in middle-aged Chinese women. Methods This cross-sectional study, conducted in 2018, included 7,727 women aged 40–60 years from the eastern, central and western regions of China. Depressive and anxiety symptoms were determined by the Patient Health Questionnaire-9 and the Generalized Anxiety Disorders-7, respectively. Logistic regression models were used to estimate odds ratios (ORs) for depressive and anxiety symptoms in relation to sociodemographic, lifestyle and menopausal factors. Results Among all participants, 19.5% (1 422/7 275) and 14.2% (1 035/7 275) of participants experienced depressive and anxiety symptoms, respectively. The multivariable logistic regression models showed that age, household income, regular physical activity, chronic diseases, menopausal status, vasomotor symptoms, somatic symptoms and urogenital symptoms were associated with depressive symptoms, while place of residence, regular physical activity, chronic diseases, vasomotor, somatic and urogenital symptoms were associated with anxiety symptoms. Conclusion Depressive and anxiety symptoms were common among middle-aged Chinese women, and certain sociodemographic, lifestyle and menopausal symptoms have an important impact on the risk of depressive and anxiety symptoms.
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Zhao Q, Pan W, Shi H, Qi F, Liu Y, Yang T, Si H, Si G. Network pharmacology and molecular docking analysis on the mechanism of Baihe Zhimu decoction in the treatment of postpartum depression. Medicine (Baltimore) 2022; 101:e29323. [PMID: 36316904 PMCID: PMC9622608 DOI: 10.1097/md.0000000000029323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Baihe Zhimu decoction (BZD) has significant antidepressant properties and is widely used to treat mental diseases. However, the multitarget mechanism of BZD in postpartum depression (PPD) remains to be elucidated. Therefore, the aim of this study was to explore the molecular mechanisms of BDZ in treating PPD using network pharmacology and molecular docking. Active components and their target proteins were screened from the traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP). The PPD-related targets were obtained from the OMIM, CTD, and GeneCards databases. After overlap, the targets of BZD against PPD were collected. Protein-protein interaction (PPI) network and core target analyses were conducted using the STRING network platform and Cytoscape software. Moreover, molecular docking methods were used to confirm the high affinity between BZD and targets. Finally, the DAVID online tool was used to perform gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis of overlapping targets. The TCMSP database showed that BZD contained 23 active ingredients in PPD. KEGG analysis showed that overlapping genes were mainly enriched in HIF-1, dopaminergic synapses, estrogen, and serotonergic synaptic signalling pathways. Combining the PPI network and KEGG enrichment analysis, we found that ESR1, MAOA, NR3C1, VEGFA, and mTOR were the key targets of PPD. In addition, molecular docking confirmed the high affinity between BZD and the PPD target. Verified by a network pharmacology approach based on data mining and molecular docking methods, the multi-target drug BZD may serve as a promising therapeutic candidate for PPD, but further in vivo/in vitro experiments are needed.
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Affiliation(s)
- Qiong Zhao
- School of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
- Department of Traditional Chinese Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Wengu Pan
- Department of Kidney transplantation, The second hospital of Shandong University, Jinan, China
| | - Hongshuo Shi
- School of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Fanghua Qi
- Department of Traditional Chinese Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Yuan Liu
- Department of Traditional Chinese Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Tiantian Yang
- Department of Traditional Chinese Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Hao Si
- Ai Kunwei Pharmaceutical Technology Co, Ltd, Shanghai, China
| | - Guomin Si
- School of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
- Department of Traditional Chinese Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
- *Correspondence: Guomin Si, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China (e-mail: )
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Schiller CE, Walsh E, Eisenlohr-Moul TA, Prim J, Dichter GS, Schiff L, Bizzell J, Slightom SL, Richardson EC, Belger A, Schmidt P, Rubinow DR. Effects of gonadal steroids on reward circuitry function and anhedonia in women with a history of postpartum depression. J Affect Disord 2022; 314:176-184. [PMID: 35777494 PMCID: PMC9605402 DOI: 10.1016/j.jad.2022.06.078] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/25/2022] [Accepted: 06/23/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Reward system dysfunction is evident across neuropsychiatric conditions. Here we present data from a double-blinded pharmaco-fMRI study investigating the triggering of anhedonia and reward circuit activity in women. METHODS The hormonal states of pregnancy and parturition were simulated in euthymic women with a history of postpartum depression (PPD+; n = 15) and those without such a history (PPD-; n = 15) by inducing hypogonadism, adding back estradiol and progesterone for 8 weeks ("addback"), and then withdrawing both steroids ("withdrawal"). Anhedonia was assessed using the Inventory of Depression and Anxiety Symptoms (IDAS) during each hormone phase. Those who reported a 30 % or greater increase in IDAS anhedonia, dysphoria, or ill temper during addback or withdrawal, compared with pre-treatment, were identified as hormone sensitive (HS+) and all others were identified as non-hormone sensitive (HS-). The monetary incentive delay (MID) task was administered during fMRI sessions at pre-treatment and during hormone withdrawal to assess brain activation during reward anticipation and feedback. RESULTS On average, anhedonia increased during addback and withdrawal in PPD+ but not PPD-. During reward feedback, both HS+ (n = 10) and HS- (n = 18) showed decreased activation in clusters in the right putamen (p < .031, FWE-corrected) and left postcentral and supramarginal gyri (p < .014, FWE-corrected) at the withdrawal scans, relative to pre-treatment scans. LIMITATIONS A modest sample size, stringent exclusion criteria, and relative lack of diversity in study participants limit the generalizability of results. CONCLUSION Although results do not explain differential hormone sensitivity in depression, they demonstrate significant effects of reproductive hormones on reward-related brain function in women.
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Affiliation(s)
- C E Schiller
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, United States of America.
| | - E Walsh
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, United States of America
| | - T A Eisenlohr-Moul
- Department of Psychiatry, University of Illinois at Chicago, United States of America
| | - J Prim
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, United States of America
| | - G S Dichter
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, United States of America
| | - L Schiff
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, United States of America
| | - J Bizzell
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, United States of America
| | - S L Slightom
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, United States of America
| | | | - A Belger
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, United States of America
| | - P Schmidt
- National Institute of Mental Health, Behavioral Endocrinology Branch, United States of America
| | - D R Rubinow
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, United States of America
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Hidaka Y, Kawakami N, Watanabe K, Nishi D. The association between premenstrual syndrome before pregnancy and antenatal depression: A cross-sectional study with prerecorded information. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2022; 1:e27. [PMID: 38868690 PMCID: PMC11114378 DOI: 10.1002/pcn5.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 05/21/2022] [Accepted: 06/05/2022] [Indexed: 06/14/2024]
Abstract
Aim Some studies have examined the relationship between premenstrual syndrome (PMS) and antenatal depression. However, retrospective designs were used to obtain the PMS experiences. Different from such earlier research, this study aims to investigate the association between PMS before pregnancy and antenatal depression with a prospective design. Method This is a secondary analysis of a randomized controlled trial (RCT) conducted among pregnant women. Premenstrual symptoms before pregnancy of the participants were obtained prospectively via a period tracking app. At the baseline of the RCT, 5073 women participated. Of those, 3004 had one or more symptom records related to menstruation 1 year before pregnancy. The outcome, antenatal depression, was assessed using the Edinburgh Postnatal Depression Scale (EPDS) at the RCT baseline, and the cut-off value was set at 11. For covariates, age, education, planned pregnancy, and the number of children were also measured at the same time. Multiple logistic regression analyses were employed to estimate the odds ratio (OR) of having antenatal depression, adjusting for the covariates. Results A total of 366 individuals who had three or more cycles of menstrual-related symptom records were included in the analyses, and of those 52 were applicable to PMS before pregnancy. There was no significant association between PMS and antenatal depression (adjusted OR = 1.28, P = 0.61). Conclusion The present study was the first study to utilize a prospective design to obtain premenstrual symptoms. Future research should consider using a validated and objective measure of PMS diagnosis and a larger sample.
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Affiliation(s)
- Yui Hidaka
- Department of Mental Health, Graduate School of MedicineThe University of TokyoBunkyo‐kuTokyoJapan
- Japan Society for the Promotion of ScienceTokyoJapan
| | - Norito Kawakami
- Department of Mental Health, Graduate School of MedicineThe University of TokyoBunkyo‐kuTokyoJapan
| | - Kazuhiro Watanabe
- Department of Public HealthKitasato University School of MedicineSagamiharaKanagawaJapan
| | - Daisuke Nishi
- Department of Mental Health, Graduate School of MedicineThe University of TokyoBunkyo‐kuTokyoJapan
- Department of Public Mental Health Research, National Institute of Mental HealthNational Center of Neurology and PsychiatryKodaira, TokyoJapan
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Kiesner J, Eisenlohr-Moul TA, Vidotto G. Affective Risk Associated With Menstrual Cycle Symptom Change. Front Glob Womens Health 2022; 3:896924. [PMID: 35936817 PMCID: PMC9353132 DOI: 10.3389/fgwh.2022.896924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
In the present study we test whether cyclical changes in affective symptoms of the menstrual cycle are associated with higher mean levels of those same symptoms. Using prospective daily reports across two full menstrual cycles, from two samples of female University students (n = 213; n = 163), we applied both quartic polynomial regressions and cosine regressions to model cyclical change in symptoms, and to test for mean-level differences in symptoms across the resulting trajectory patterns. Counter to prior findings, but consistent with theoretical expectations, these results show that females who experience menstrual cycle-related changes in affect (whether a perimenstrual or mid-cycle increase) are at risk for higher average levels of affective symptoms. These results suggest that the mid-cycle group should be recognized as a target for future research that is associated with increased risk for chronic negative affective symptoms.
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Affiliation(s)
- Jeff Kiesner
- Department of Developmental and Social Psychology, University of Padova, Padua, Italy
- *Correspondence: Jeff Kiesner
| | | | - Giulio Vidotto
- Department of General Psychology, University of Padova, Padua, Italy
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Andersen E, Fiacco S, Gordon J, Kozik R, Baresich K, Rubinow D, Girdler S. Methods for characterizing ovarian and adrenal hormone variability and mood relationships in peripubertal females. Psychoneuroendocrinology 2022; 141:105747. [PMID: 35398750 PMCID: PMC9149069 DOI: 10.1016/j.psyneuen.2022.105747] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 10/18/2022]
Abstract
Peripubertal females are at elevated risk for developing affective illness compared to males, yet biological mechanisms underlying this sex disparity are poorly understood. Female risk for depression remains elevated across a woman's reproductive lifespan, implicating reproductive hormones. A sensitivity to normal hormone variability during reproductive transition events (e.g., perimenopause) precipitates affective disturbances in susceptible women; however, the extent of hormone variability during the female pubertal transition and whether vulnerability to peripubertal hormone flux impacts affective state change in peripubertal females has not been studied. 52 healthy peripubertal females (ages 11-14) provided 8 weekly salivary samples and mood ratings. 10 salivary ovarian and adrenal hormones (e.g., estrone, testosterone, dehydroepiandrosterone (DHEA)) were analyzed weekly for 8 weeks using an ultrasensitive assay to characterize the female peripubertal hormone environment and its association with affective state. Hormone variability indices, including standard deviation, mean squared and absolute successive differences of the 8 weekly measurements were analyzed by menarche status. Within-person partial correlations were computed to determine the strength of the relationship between weekly change in hormone level and corresponding mood rating for each participant. As expected, results indicated that hormone variability was greater for post- relative to pre-menarchal females and with advancing pubertal development, yet pregnenolone-sulfate and aldosterone did not differ by menarche status. Mood sensitivity to changes in estrone was exhibited by 57% of participants, whereas 37% were sensitive to testosterone and 6% were sensitive to DHEA changes. The present results offer novel evidence that a substantial proportion of peripubertal females appear to be mood sensitive to hormone changes and may inform future investigations on the biological mechanisms underlying hormone-induced affect dysregulation in peripubertal females.
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Affiliation(s)
- Elizabeth Andersen
- Department of Psychiatry, University of North Carolina-Chapel Hill, CB 7160, Chapel Hill, NC 27517, United States.
| | - Serena Fiacco
- Department of Psychiatry, University of North Carolina-Chapel Hill, CB 7160, Chapel Hill, NC 27517, United States; Clinical Psychology Behavioral Analytics Lab, Department of Psychology, University of Zurich, Binzmuehlestrasse 14, Box 1, 8050 Zurich, Switzerland.
| | - Jennifer Gordon
- Department of Psychology, University of Regina, 3737 Wascana Parkway Regina, Saskatchewan S4S 0A2, Canada.
| | - Rachel Kozik
- Department of Psychiatry, University of North Carolina-Chapel Hill, CB 7160, Chapel Hill, NC 27517, United States.
| | - Kayla Baresich
- Department of Psychiatry, University of North Carolina-Chapel Hill, CB 7160, Chapel Hill, NC 27517, United States.
| | - David Rubinow
- Department of Psychiatry, University of North Carolina-Chapel Hill, CB 7160, Chapel Hill, NC 27517, United States.
| | - Susan Girdler
- Department of Psychiatry, University of North Carolina-Chapel Hill, CB 7160, Chapel Hill, NC 27517, United States.
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Can animal models resemble a premenstrual dysphoric condition? Front Neuroendocrinol 2022; 66:101007. [PMID: 35623450 DOI: 10.1016/j.yfrne.2022.101007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/22/2022] [Accepted: 05/19/2022] [Indexed: 11/23/2022]
Abstract
Around 80% of women worldwide suffer mild Premenstrual Disorders (PMD) during their reproductive life. Up to a quarter are affected by moderate to severe symptoms, and between 3% and 8% experience a severe form. It is classified as premenstrual syndrome (PMS) with predominantly physical symptoms and premenstrual dysphoric disorder (PMDD) with psychiatric symptoms. The present review analyzes the factors associated with PMD and the Hypothalamus-Pituitary-Ovarian or Hypothalamus-Pituitary-adrenal axis and discusses the main animal models used to study PMDD. Evidence shows that the ovarian hormones participate in PMDD symptoms, and several points of regulation of their synthesis, metabolism, and target sites could be altered. PMDD is complex and implies several factors that require consideration when this condition is modeled in animals. Of particular interest are those points related to areas that may represent opportunities to develop new approximations to understand the mechanisms involved in PMDD and possible treatments.
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Itriyeva K. Premenstrual syndrome and premenstrual dysphoric disorder in adolescents. Curr Probl Pediatr Adolesc Health Care 2022; 52:101187. [PMID: 35534402 DOI: 10.1016/j.cppeds.2022.101187] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) represent two premenstrual disorders characterized by physical and psychological symptoms that occur in the luteal phase of the menstrual cycle, prior to the onset of menses, and have a negative impact on the psychosocial functioning of affected individuals. PMS, more common than PMDD, affects 20-40% of menstruating women, with common symptoms including fatigue, irritability, mood swings, depression, abdominal bloating, breast tenderness, acne, changes in appetite and food cravings. PMDD, affecting a smaller percentage of women, is characterized by more severe symptoms and is listed as a depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). While the pathophysiology of these premenstrual disorders remains unclear, it has been hypothesized that sensitivity to hormonal fluctuations during the luteal phase of the menstrual cycle, abnormal serotonergic activity, and aberrations in progesterone and the neurotransmitter gamma aminobutyric acid (GABA) may all play a role in these disorders. Treatment of PMS and PMDD is focused on alleviation of symptoms and improvement of functioning and quality of life for affected individuals. The treatment of severe PMS and PMDD typically requires pharmacologic therapy with selective serotonin reuptake inhibitors (SSRIs), oral contraceptive pills (OCPs), gonadotropin-releasing hormone (GnRH) agonists, and non-contraceptive estrogen formulations. Non-pharmacologic treatment with diet, exercise, cognitive behavioral therapy (CBT), certain vitamin and herbal supplements, and acupuncture may additionally be effective for some individuals.
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Affiliation(s)
- Khalida Itriyeva
- Division of Adolescent Medicine, Cohen Children's Medical Center Northwell Health, New Hyde Park, NY, United States; Donald and Barbara Zucker School of Medicine at Hofstra / Northwell, Hempstead, NY, United States.
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Morishita C, Inoue T, Honyashiki M, Ono M, Iwata Y, Tanabe H, Kusumi I, Masuya J. Roles of childhood maltreatment, personality traits, and life stress in the prediction of severe premenstrual symptoms. Biopsychosoc Med 2022; 16:11. [PMID: 35484626 PMCID: PMC9052504 DOI: 10.1186/s13030-022-00240-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 04/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND About 3% to 8% of women of fertile age are thought to have premenstrual dysphoric disorder (PMDD), which is regarded as a serious form of premenstrual syndrome (PMS), although the details of this common condition remain unclear. The aim of this study was to analyze the interrelations of childhood maltreatment, personality traits, and life stress in the etiology of PMS/PMDD. METHODS A total of 240 adult female volunteers from a community in Japan were investigated, using the following 5 questionnaires: Patient Health Quesstionaire-9, Child Abuse and Trauma Scale, Temperament and Character Inventory (TCI), Life Experiences Survey, and premenstrual dysphoric disorder (PMDD) scale. The questionnaire data were subjected to path analyses to clarify the association between childhood maltreatment and the severity of premenstrual symptoms, mediated by personality traits and life stress. RESULTS The 2 path analysis models showed that high harm avoidance (HA) on the TCI and low self-directedness (SD) on the TCI had significant direct effects on the severity of premenstrual symptoms. Moreover, childhood maltreatment was associated with the severity of premenstrual symptoms, both directly and indirectly through personality traits. CONCLUSION Our findings suggest that HA on the TCI might be a risk factor for severe premenstrual symptoms among general women and furthermore that SD on the TCI may be a protective factor. In addition, childhood maltreatment is associated with severe premenstrual symptoms both directly and indirectly through personality traits.
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Affiliation(s)
- Chihiro Morishita
- Department of Psychiatry, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Takeshi Inoue
- Department of Psychiatry, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Mina Honyashiki
- Department of Psychiatry, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Miki Ono
- Department of Psychiatry, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Yoshio Iwata
- Department of Psychiatry, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Hajime Tanabe
- Faculty of Humanities and Social Sciences, Shizuoka University, 836 Ohya, Suruga-ku, Shizuoka, 422-8529, Japan
| | - Ichiro Kusumi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Jiro Masuya
- Department of Psychiatry, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
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Chamali R, Emam R, Mahfoud ZR, Al-Amin H. Dimensional (premenstrual symptoms screening tool) vs categorical (mini diagnostic interview, module U) for assessment of premenstrual disorders. World J Psychiatry 2022; 12:603-614. [PMID: 35582334 PMCID: PMC9048450 DOI: 10.5498/wjp.v12.i4.603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 10/23/2021] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Premenstrual syndrome (PMS) is the constellation of physical and psychological symptoms before menstruation. Premenstrual dysphoric disorder (PMDD) is a severe form of PMS with more depressive and anxiety symptoms. The Mini international neuropsychiatric interview, module U (MINI-U), assesses the diagnostic criteria for probable PMDD. The Premenstrual Symptoms screening tool (PSST) measures the severity of these symptoms.
AIM To compare the PSST ordinal scores with the corresponding dichotomous MINI-U answers.
METHODS Arab women (n = 194) residing in Doha, Qatar, received the MINI-U and PSST. Receiver Operating Characteristics (ROC) analyses provided the cut-off scores on the PSST using MINI-U as a gold standard.
RESULTS All PSST ratings were higher in participants with positive responses on MINI-U. In addition, ROC analyses showed that all areas under the curves were significant with the cutoff scores on PSST.
CONCLUSION This study confirms that the severity measures from PSST can recognize patients with moderate/ severe PMS and PMDD who would benefit from immediate treatment.
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Affiliation(s)
- Rifka Chamali
- Department of Research, Weill Cornell Medicine - Qatar, Doha 00974, Qatar
| | - Rana Emam
- Department of Psychiatry, Hamad Medical Corporation, Doha 00974, Qatar
| | - Ziyad R Mahfoud
- Department of Medical Education, Weill Cornell Medicine - Qatar, Doha 00974, Qatar
- Division of Epidemiology, Department of Population of Health Sciences, Weill Cornell Medicine, New York 10065, NY, United States
| | - Hassen Al-Amin
- Department of Psychiatry, Weill Cornell Medicine - Qatar, Doha 00974, Qatar
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Effects of circulating estradiol on physiological, behavioural, and subjective correlates of anxiety: A double-blind, randomized, placebo-controlled trial. Psychoneuroendocrinology 2022; 138:105682. [PMID: 35123210 DOI: 10.1016/j.psyneuen.2022.105682] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 12/17/2021] [Accepted: 01/27/2022] [Indexed: 12/15/2022]
Abstract
Anxiety-related behaviours as well as the prevalence of anxiety disorders show a large sex difference in humans. Clinical studies in humans as well as behavioural studies in rodents suggest that estradiol may have anxiolytic properties. In line with this, anxiety symptoms fluctuate with estradiol levels along the menstrual cycle. However, the influence of estradiol on subjective, behavioural, as well as physiological correlates of anxiety has never been systematically addressed in humans. We ran a double-blind, randomized, placebo-controlled study (N = 126) to investigate the effects of estradiol on anxiety in men and women. In healthy volunteers, circulating estradiol levels were elevated through estradiol administration over two consecutive days to simulate the rise in estradiol levels around ovulation. Subjective, behavioral, as well as, physiological correlates of anxiety were assessed using a virtual reality elevated plus-maze (EPM). Estradiol treatment reduced the physiological stress response with blunted heart rate response and lower cortisol levels compared to placebo treatment in both sexes. In contrast, respiration frequency was only reduced in women after estradiol treatment. Behavioural measures of anxiety as well as subjective anxiety on the EPM were not affected by estradiol treatment. In general, women showed more avoidance and less approach behavior and reported higher subjective anxiety levels on the EPM than men. These results highlight the limited anxiolytic properties of circulating levels of estradiol in humans, which influence physiological markers of anxiety but not approach and avoidance behaviour or subjective anxiety levels.
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Investigating biological rhythms disruptions across the menstrual cycle in women with comorbid bipolar disorder and premenstrual dysphoric disorder. Arch Womens Ment Health 2022; 25:345-353. [PMID: 35226173 DOI: 10.1007/s00737-022-01220-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/22/2022] [Indexed: 11/02/2022]
Abstract
We investigated whether women diagnosed with comorbid bipolar disorder (BD) and premenstrual dysphoric disorder (PMDD) experience higher disruptions in biological rhythms in two independent study samples. The first study has a population-based sample of 727 women, including 104 women with PMDD only, 43 women with BD only, 24 women with comorbid PMDD and BD, and 556 women without BD or PMDD (controls). Biological rhythm disruptions were cross-sectionally evaluated using the Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN). The second study enrolled 77 outpatient women who completed prospective assessments at two timepoints: during the mid-follicular and the late-luteal phases of their menstrual cycles, using the BRIAN, and included 19 women with PMDD, 16 with BD, 17 with comorbid PMDD and BD, and 25 controls. In the population-based sample, all the diagnostic groups (BD, PMDD, BDPMDD) presented greater biological rhythm disruption than controls. In addition, women with BD presented greater overall biological rhythms disruption, and greater disruption in sleep, activity, and eating patterns, than women with PMDD. In the outpatient sample study, women with BDPMDD showed greater disruption in the social domain than women with PMDD. In the outpatient sample, women with BDPMDD reported significantly higher disruptions in biological rhythms across both the follicular and the luteal phases of the menstrual cycle. The comorbidity between BD and PMDD may affect biological rhythms beyond the luteal phase of the menstrual cycle. These results support previous literature on the increased illness burden of women diagnosed with comorbid BD and PMDD.
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Eisenlohr-Moul T, Divine M, Schmalenberger K, Murphy L, Buchert B, Wagner-Schuman M, Kania A, Raja S, Miller AB, Barone J, Ross J. Prevalence of lifetime self-injurious thoughts and behaviors in a global sample of 599 patients reporting prospectively confirmed diagnosis with premenstrual dysphoric disorder. BMC Psychiatry 2022; 22:199. [PMID: 35303811 PMCID: PMC8933886 DOI: 10.1186/s12888-022-03851-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/02/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Suicide is the second leading cause of death among Americans ages 10 to 34, with alarming recent increases in suicide rates among those assigned female at birth. A large body of evidence points to menstrual cycle influences on self-injurious thoughts and behaviors (STBs), suggesting that neurobiological hormone sensitivities, such as in premenstrual dysphoric disorder (PMDD), may drive suicide risk in females. However, existing studies of STBs in PMDD use cross-sectional self-report measures of PMDD with poor validity. As a first step to establish accurate prevalence rates of STBs in PMDD, we examined the lifetime prevalence of STBs in a large global survey of patients reporting a diagnosis of PMDD based on daily ratings. METHOD Individuals with self-reported PMDD symptoms were invited to an online survey through online support groups for PMDD and social media posts from PMDD awareness accounts. Participants reported demographics, whether they had been diagnosed with PMDD by a healthcare provider using daily ratings, STBs using the Columbia Suicide Severity Rating Scale, and history of lifetime comorbid psychiatric diagnoses. RESULTS Of 2,689 survey completers, 599 (23%) reported a diagnosis with PMDD based on two months of daily ratings and were included in analyses. We observed high rates of lifetime active suicidal ideation (72%), planning (49%), intent (42%), preparing for an attempt (40%), and attempt (34%), as well as non-suicidal self-injury (51%). The majority (70%) of the sample reported at least one lifetime comorbid psychiatric diagnosis. Predictors of lifetime active suicidal ideation included nulliparity, low-to-moderate (vs. high) income, and history of diagnosis with major depression or post-traumatic stress disorder. Predictors of lifetime attempts among those reporting lifetime active ideation included older age, nulliparity, lower income, and history of diagnosis with post-traumatic stress disorder or borderline personality disorder. CONCLUSIONS These data indicate high rates of STBs among those reporting prospective diagnosis of PMDD and highlight the need for prospective research on mechanisms and prevention of STBs in PMDD. Clinical practice guidelines for PMDD should accommodate comorbidities and recommend frequent screenings for STB risk. STBs should be considered for inclusion in future iterations of the DSM PMDD diagnostic criteria.
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Affiliation(s)
- Tory Eisenlohr-Moul
- Department of Psychiatry, University of Illinois at Chicago, 912 South Wood Street, Chicago, IL, 60612, USA.
- International Association for Premenstrual Disorders, Boston, MA, USA.
| | - Madeline Divine
- Department of Psychiatry, University of Illinois at Chicago, 912 South Wood Street, Chicago, IL, 60612, USA
- University of Texas at Austin, Austin, TX, USA
| | - Katja Schmalenberger
- International Association for Premenstrual Disorders, Boston, MA, USA
- Heidelberg University, Heidelberg, Germany
| | - Laura Murphy
- International Association for Premenstrual Disorders, Boston, MA, USA
| | - Brett Buchert
- International Association for Premenstrual Disorders, Boston, MA, USA
| | - Melissa Wagner-Schuman
- Department of Psychiatry, University of Illinois at Chicago, 912 South Wood Street, Chicago, IL, 60612, USA
- University of Cincinnati, Cincinnati, OH, USA
| | - Alyssa Kania
- Department of Psychiatry, University of Illinois at Chicago, 912 South Wood Street, Chicago, IL, 60612, USA
| | - Sabina Raja
- Department of Psychiatry, University of Illinois at Chicago, 912 South Wood Street, Chicago, IL, 60612, USA
| | - Adam Bryant Miller
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- RTI International, Raleigh, NC, USA
| | - Jordan Barone
- Department of Psychiatry, University of Illinois at Chicago, 912 South Wood Street, Chicago, IL, 60612, USA
| | - Jaclyn Ross
- Department of Psychiatry, University of Illinois at Chicago, 912 South Wood Street, Chicago, IL, 60612, USA
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Premenstrual Syndrome and Premenstrual Dysphoric Disorder as Centrally Based Disorders. ENDOCRINES 2022. [DOI: 10.3390/endocrines3010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) encompass a variety of symptoms that occur during the luteal phase of the menstrual cycle and impair daily life activities and relationships. Depending on the type and severity of physical, emotional or behavioral symptoms, women of reproductive age followed for at least two prospective menstrual cycles may receive one of the two diagnoses. PMDD is the most severe form of PMS, predominantly characterized by emotional and behavioral symptoms not due to another psychiatric disorder. PMS and PMDD are common neuro-hormonal gynecological disorders with a multifaceted etiology. Gonadal steroid hormones and their metabolites influence a plethora of biological systems involved in the occurrence of specific symptoms, but there is no doubt that PMS/PMDD are centrally based disorders. A more sensitive neuroendocrine threshold to cyclical variations of estrogens and progesterone under physiological and hormonal therapies is present. Moreover, altered brain sensitivity to allopregnanolone, a metabolite of progesterone produced after ovulation potentiating GABA activity, along with an impairment of opioid and serotoninergic systems, may justify the occurrence of emotional and behavioral symptoms. Even neuro-inflammation expressed via the GABAergic system is under investigation as an etiological factor of PMS/PMDD. Pharmacological management aims to stabilize hormonal fluctuations and to restore the neuroendocrine balance. The rationale of suppressing ovulation supports prescription of combined hormonal contraception (CHC). Its effect on mood is highly variable and depends on biochemical characteristics of exogenous steroids and on type and severity of symptoms. Hormonal regimens reducing the estrogen-free interval or suppressing menstruation seem better choices. Psychoactive agents, such as serotonin reuptake inhibitors (SSRIs), are effective in reducing the symptoms of PMS/PMDD and may be prescribed continuously or only during the luteal phase. Novel therapeutic approaches include inhibition of progesterone receptors in the brain, i.e., with ulipristal acetate, reduced conversion of progesterone with dutasteride, and modulation of the action of allopregnanolone on the brain GABAergic system with sepranolone.
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