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Emanuel RHK, Docherty PD, Lunt H, Campbell RE. What do users in a polycystic ovary syndrome (PCOS) forum think about the treatments they tried: Analysing treatment sentiment using machine learning. Phys Eng Sci Med 2025:10.1007/s13246-025-01539-9. [PMID: 40227526 DOI: 10.1007/s13246-025-01539-9] [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: 10/18/2024] [Accepted: 03/29/2025] [Indexed: 04/15/2025]
Abstract
Polycystic ovary syndrome (PCOS) is a heterogenous condition that is estimated to effect up to 21% of reproductive aged people with ovaries. In previous work, a dataset of PCOS features was derived from approximately 100,000 PCOS subreddit users via machine learning. In this study, an exploration of treatment response within the PCOS subreddit was undertaken with the derived dataset. The treatment or symptom features in the dataset had sentiment labels indicating when a treatment was perceived to improve or worsen a condition or symptom. When different features were mentioned within two sentences of each other without conflicting sentiment, it could be assumed that they were related. This assumption allowed for a broad analysis of the perceived effect of popular treatments on the most frequently mentioned symptoms. In general, lifestyle changes and supplements were the most positively regarded, while contraceptives were frequently associated with considerable negative sentiment. For PCOS weight loss, unspecified dieting (RR 5.19, 95% CI 3.28-8.19, n = 99) and intermittent fasting (RR 33.50, 95% CI 8.54-131.34, n = 69) were the most successful interventions. Inositol was associated with a large range of favourable outcomes and was one of the few treatments associated with improved mental health [depression (RR 4.25, 95% CI 1.72-10.51, n = 21), anxiety (RR 5.83, 95% CI 2.76-12.35, n = 41) and mood issues (RR 25.00, 95% CI 3.65-171.10, n = 26)]. Combined oral contraceptive pills as a whole were strongly associated with adverse effects such as worsening depression (RR 0.06, 95% CI 0.02-0.25, n = 33), anxiety (RR 0.10, 95% CI 0.03-0.36, n = 23), fatigue (RR 0, n = 45) and low libido (RR 0.03, 95% CI 0.01-0.24, n = 30). However, combined contraceptives with anti-androgenic progestins were associated with more favourable experiences. This study demonstrates the utility of machine learning to derive measurable patient experience data from an internet forum. While patient experience data derived using machine learning is not a substitute for traditional clinical trials, it is useful for mass validation and hypothesis generation. This paper may serve as the first exploration into this category of clinical internet forum research.
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Affiliation(s)
- Rebecca H K Emanuel
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Paul D Docherty
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand.
- Institute for Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany.
| | - Helen Lunt
- Diabetes Services, Health New Zealand, Canterbury, New Zealand
| | - Rebecca E Campbell
- School of Biomedical Sciences, Department of Physiology, Centre for Neuroendocrinology, University of Otago, Dunedin, New Zealand
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2
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Lee BH, Eid RS, Hodges TE, Barth C, Galea LAM. Leveraging research into sex differences and steroid hormones to improve brain health. Nat Rev Endocrinol 2025; 21:214-229. [PMID: 39587332 DOI: 10.1038/s41574-024-01061-0] [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: 10/28/2024] [Indexed: 11/27/2024]
Abstract
Sex differences, driven in part by steroid hormones, shape the structure and function of the brain throughout the lifespan and manifest across brain health and disease. The influence of steroid hormones on neuroplasticity, particularly in the adult hippocampus, differs between the sexes, which has important implications for disorders and diseases that compromise hippocampus integrity, such as depression and Alzheimer disease. This Review outlines the intricate relationship between steroid hormones and hippocampal neuroplasticity across the adult lifespan and explores how the unique physiology of male and female individuals can affect health and disease. Despite calls to include sex and gender in research, only 5% of neuroscience studies published in 2019 directly investigated the influence of sex. Drawing on insights from depression, Alzheimer disease and relevant hippocampal plasticity, this Review underscores the importance of considering sex and steroid hormones to achieve a comprehensive understanding of disease susceptibility and mechanisms. Such consideration will enable the discovery of personalized treatments, ultimately leading to improved health outcomes for all.
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Affiliation(s)
- Bonnie H Lee
- Graduate Program in Neuroscience, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rand S Eid
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Travis E Hodges
- Department of Psychology and Education, Mount Holyoke College, South Hadley, MA, USA
| | - Claudia Barth
- Division for Mental Health and Substance Abuse, Diakonhjemmet Hospital, Oslo, Norway
| | - Liisa A M Galea
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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Bosmans NHM, Zarchev M, Berges L, Kamperman AM, Poels EMP, Hoogendijk WJG, Grootendorst-van Mil NH. Associations between oral hormonal contraceptives and internalising problems in adolescent girls. BJPsych Open 2025; 11:e40. [PMID: 40034053 PMCID: PMC12001913 DOI: 10.1192/bjo.2024.859] [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: 05/29/2024] [Revised: 12/03/2024] [Accepted: 12/14/2024] [Indexed: 03/05/2025] Open
Abstract
BACKGROUND Oral contraceptive pills (OCP) have received increased critical attention recently owing to their perceived link with mental health, especially among adolescent girls. The empirical literature, however, includes mixed findings on whether OCP use is associated with poorer mental health. AIMS To examine the association between the use of OCP and internalising problems in adolescent girls. METHODS This study was embedded in the iBerry study, a population-based cohort of adolescents oversampled for behavioural and emotional problems from the greater Rotterdam area, The Netherlands. In 372 girls, internalising problems were measured using the Youth Self Report, and use of OCP was determined by parental interview and self-report questionnaire across two subsequent waves (mean ages 14.9 and 17.9 years, respectively). Multiple regression analyses were performed to determine the association. Analyses were adjusted for various sociodemographic factors and adjusted for previous internalising problems assessed at a mean age of 14.9 years. RESULTS In total, 204 girls (54.8%) used OCP. OCP use was associated with fewer internalising problems in adolescent girls compared with non-use (adjusted β = -2.22, 95% CI [-4.24, -0.20]; P = 0.031). CONCLUSIONS In this research, we found that adolescent girls using OCP reported fewer internalising problems compared with non-users. This association was most prominent for girls with pre-existing internalising problems. Although healthy user bias may have a role, our observations suggest a potential therapeutic benefit for those with greater baseline challenges.
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Affiliation(s)
- Nadie H. M. Bosmans
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Milan Zarchev
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Leonie Berges
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Astrid M. Kamperman
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Epidemiological and Social Psychiatric Research Institute, Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Eline M. P. Poels
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Witte J. G. Hoogendijk
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Nina H. Grootendorst-van Mil
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Epidemiological and Social Psychiatric Research Institute, Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Mengelkoch S, Afshar K, Slavich GM. Hormonal Contraceptive Use and Affective Disorders: An Updated Review. Open Access J Contracept 2025; 16:1-29. [PMID: 39959454 PMCID: PMC11829607 DOI: 10.2147/oajc.s431365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2024] [Accepted: 01/17/2025] [Indexed: 02/18/2025] Open
Abstract
Hormonal contraceptives have given women historic freedoms and control over their fertility. At the same time, the potential side effects and unintended consequences of hormonal contraceptive use remain unclear due to a severe lack of funding and research. In this review, we summarize what is currently known about the impact of hormonal contraceptive use on mood symptoms, depression, and premenstrual disorders, and propose using the Social Signal Transduction Theory of Depression as a framework to generate predictions about the mechanistic pathways through which contraceptive use is associated with depression risk. The highest-quality evidence suggests that some types of contraceptives increase depression risk for some women. However, some contraceptives also appear to decrease depression risk in some instances. Key risk factors that predict depression following hormonal contraceptive use include age/age at onset of contraceptive use and mental health history/susceptibility. Hormonal contraceptives differ in ways that influence mood-related outcomes and can be used to treat depression in some women, especially those whose depression symptoms fluctuate across the cycle, indicating the potential presence of a premenstrual disorder. Looking forward, research, and funding for this research, is needed to elucidate the mechanistic pathways through which the use of different contraceptives impacts mood in different women to allow for a precision medicine approach to contraceptive treatment. In the meantime, health care providers should adopt patient-centered, "mindful prescribing" approaches to contraceptive counseling.
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Affiliation(s)
- Summer Mengelkoch
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Kimya Afshar
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - George M Slavich
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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Black KI, Vromman M, French RS. Common myths and misconceptions surrounding hormonal contraception. Best Pract Res Clin Obstet Gynaecol 2025; 98:102573. [PMID: 39705740 DOI: 10.1016/j.bpobgyn.2024.102573] [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: 06/01/2024] [Revised: 11/08/2024] [Accepted: 11/15/2024] [Indexed: 12/22/2024]
Abstract
Numerous community and professional myths and misconceptions around hormonal contraception exist, many promulgated through social media. As a result of these and other factors, people are moving away from hormonal methods and potentially exposing themselves to increased risk of unintended pregnancy. A number of key myths and misconceptions have been identified in a range of papers and here we summarise the evidence around the basis for these misunderstandings. The themes we explore are the physical side effects, the mental health effects, the impact on sexuality, the concerns about infertility, the concept of "unnaturalness", concerns about menstruation, concerns about safety and destigmatisation of side effects. For many of these themes, there is some evidence justifying the concern, but overall for most people, we argue that the benefits of hormonal contraception outweigh the disadvantages.
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Affiliation(s)
- Kirsten I Black
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Maxime Vromman
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Rebecca S French
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Khalaf A, Al Amri N, Ny P, Mathew R. Association of contraception use and pregnancy intention with perinatal depression risk among Omani mothers-a longitudinal cohort study. Front Glob Womens Health 2025; 6:1497698. [PMID: 39963608 PMCID: PMC11831608 DOI: 10.3389/fgwh.2025.1497698] [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: 09/17/2024] [Accepted: 01/13/2025] [Indexed: 02/20/2025] Open
Abstract
Background Unplanned pregnancy is significantly associated with an increased risk of perinatal depression (antenatal and postnatal depression), emphasizing its prevalence and its potentially detrimental effects on both maternal and child health. This study aimed to investigate the association of contraception use and pregnancy intention with the risk of perinatal depression among Omani mothers. Methods A prospective longitudinal study design was employed to investigate perinatal depression risk in mothers attending antenatal health care services in Oman. Perinatal depression risk was assessed using the Edinburgh Postpartum Depression Scale during the third trimester and postpartum visits. Multiple linear regression analyses were utilized to explore relationships between the risk of perinatal depression and pregnancy-related factors, contraception use, and sociodemographic variables. Results The study involved 300 participants with a mean age of 30.8 years (SD = 5.47). The majority of participants reported planned pregnancy (74.0%), no use of contraception (66.0%), and being multiparous (72.7%). A significantly higher proportion (87.8%) of women with planned pregnancies were primiparous (p < 0.001). Besides family structure (core family, p = 0.025) and monthly income (1,000 OMR or below, p = 0.021), mothers who were pregnant for the first time (p < 0.001), and those who were primiparous (p < 0.001) did not use contraception. The regression models showed a significant association between the antenatal and postnatal depression scores (p < 0.001, 95% CI 0.401-0.603) according to the Edinburgh Postpartum Depression Scale. Conclusions The findings suggest that women with unplanned pregnancies warrant attention for early detection and preventive interventions, irrespective of their emotional stance. Incorporating routine mental health screening into perinatal care can facilitate early detection, and targeted interventions, contributing to improved maternal mental well-being.
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Affiliation(s)
- Atika Khalaf
- The PRO-CARE Group, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
- Hind Bint Maktoum College of Nursing and Midwifery, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
| | - Nawal Al Amri
- Maternal and Child Health Department, College of Nursing, Sultan Qaboos University, Muscat, Oman
| | - Pernilla Ny
- Department of Health Science, Faculty of Medicine, Lund University, Lund, Sweden
| | - Rebecca Mathew
- Instructor Nursing, Fatima College of Health Sciences, Ajman, United Arab Emirates
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Saei Ghare Naz M, Ghasemi V, Amirshekari S, Ramezani Tehrani F. Polycystic Ovary Syndrome and Irritable Bowel Syndrome: Is There a Common Pathway? Endocrinol Diabetes Metab 2024; 7:e00477. [PMID: 38494583 PMCID: PMC10944984 DOI: 10.1002/edm2.477] [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: 01/09/2024] [Revised: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVE Little is known about how polycystic ovary syndrome (PCOS) is linked to irritable bowel syndrome (IBS). This study aimed to review the existing literature regarding the association between PCOS or its symptoms and complications with IBS. METHODS In this review, studies that investigated the proposed cross-link between features of PCOS and IBS were included. This review collectively focused on recent findings on the mechanism and novel insight regarding the association between IBS and PCOS in future clinical practice. An electronic search of PubMed, Scopus, Epistemonikos, Cochrane Library and Google Scholar was performed. We did not restrict the study setting and publication date. RESULTS The existing evidence has not completely answered the question of whether there is an association between PCOS and IBS and vice versa. Six case-control studies (793 women with PCOS and 547 women in the control group) directly assessed the association between PCOS and IBS. The prevalence of IBS among women with PCOS in these studies has ranged from 10% to 52% compared with 5%-50% in control groups. Evidence suggested the common pathways may have contributed to the interaction between IBS and PCOS, including metabolic syndrome, sex hormone fluctuation, dysregulation of neurotransmitters, psychological problems and environmental and lifestyle factors. To date, it is still ambiguous which of the mentioned components largely contributes to the pathogenesis of both. CONCLUSION Although limited evidence has shown a higher prevalence of IBS in women with PCOS, there are several potential, direct and common indirect pathways contributing to the development of both IBS and PCOS.
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Affiliation(s)
- Marzieh Saei Ghare Naz
- Reproductive Endocrinology Research Center, Research Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
| | | | - Shabahang Amirshekari
- Reproductive Endocrinology Research Center, Research Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
- The Foundation for Research & Education ExcellenceVestavia HillsAlabamaUSA
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Alur-Gupta S, Dokras A, Cooney LG. Management of polycystic ovary syndrome must include assessment and treatment of mental health symptoms. Fertil Steril 2024; 121:384-399. [PMID: 38244713 DOI: 10.1016/j.fertnstert.2024.01.018] [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: 11/16/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/22/2024]
Abstract
Polycystic ovary syndrome (PCOS) is an endocrine disorder with reproductive and metabolic manifestations affecting millions of women worldwide. The health risks associated with PCOS, however, go beyond physical health. Over the past decade, data have emerged demonstrating a high risk of concurrent mental health conditions, specifically depression and anxiety, but extending into other aspects of psychological health, including body image distress, eating disorders, and sexual dysfunction. International surveys suggest physician knowledge about the mental health associations with PCOS is poor and that patients are often dissatisfied regarding counseling-related psychological issues. We performed a review of mental health comorbidities in individuals with PCOS, including depression, anxiety, body image distress, eating disorders, psychosexual dysfunction, and decreased quality of life, as well as evaluated the impact of common PCOS treatments on these conditions. Most meta-analyses in reproductive age women demonstrate increased risks of these conditions, although data are more limited in adolescents and older adults. In addition, the impact of PCOS treatments on these conditions as well as data on first-line treatments in the PCOS population is limited. All providers involved in the multidimensional care of individuals with PCOS should be aware of these mental health risks to provide appropriate screening, counseling and referral options. Future studies should be designed to evaluate targeted treatment for individuals with PCOS.
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Affiliation(s)
- Snigdha Alur-Gupta
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, New York.
| | - Anuja Dokras
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Laura G Cooney
- Department of Obstetrics and Gynecology, University of Wisconsin, Middleton, Wisconsin
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Galvin LJ, Nel YM. Contraceptive use in women with mental illness in Soweto, South Africa. S Afr J Psychiatr 2024; 30:2153. [PMID: 38322177 PMCID: PMC10839196 DOI: 10.4102/sajpsychiatry.v30i0.2153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 11/28/2023] [Indexed: 02/08/2024] Open
Abstract
Background The psychosocial and medical implications of unplanned pregnancy in women with mental illness (MI) are vast. International guidelines make clear recommendations about family planning for women with MI, particularly those exposed to known human teratogens; however, there is limited research related to contraceptive usage among women with MI. Aim The aim of this study was to investigate the prevalence of consistent contraceptive use and family planning education (FPE) among a population of women of childbearing age with MI. Setting This quantitative cross-sectional study was conducted at Chris Hani Baragwanath psychiatric unit in Soweto, South Africa. Methods A convenience sample comprising 190 eligible women of childbearing age with MI was employed for the study. The women were invited to participate by means of a structured questionnaire which was administered by the researcher. Clinical information was obtained from the patients' medical records. Results Consistent contraceptive usage occurred in 44.7% of participants. Family planning education was low (26.8%). Relationship status was associated with using contraception consistently (p = 0.0229). Teratogen exposure was not associated with either contraceptive use or FPE. Family planning education was not associated with contraceptive use. Conclusion Women with MI may have increased risk for unplanned pregnancy if they are not in a relationship because of perceived lack of need for contraception. Contribution Family planning education must be prioritised in women with MI, especially among women prescribed teratogenic medication, highlighting the risks associated with unplanned pregnancy.
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Affiliation(s)
- Lisa J Galvin
- Department of Psychiatry, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Perinatal HIV Research Unit, Wits Health Consortium, University of the Witwatersrand, Johannesburg, South Africa
| | - Yvette M Nel
- Department of Psychiatry, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Yoon S, Kim YK. Endocrinological Treatment Targets for Depressive Disorder. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1456:3-25. [PMID: 39261421 DOI: 10.1007/978-981-97-4402-2_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
Depressive disorder exhibits heterogeneity in clinical presentation, progression, and treatment outcomes. While conventional antidepressants based on the monoamine hypothesis benefit many patients, a significant proportion remains unresponsive or fails to fully recover. An individualized integrative treatment approach, considering diverse pathophysiologies, holds promise for these individuals. The endocrine system, governing physiological regulation and organ homeostasis, plays a pivotal role in central nervous system functions. Dysregulations in endocrine system are major cause of depressive disorder due to other medical conditions. Subtle endocrine abnormalities, such as subclinical hypothyroidism, are associated with depression. Conversely, depressive disorder correlates with endocrine-related biomarkers. Fluctuations in sex hormone levels related to female reproduction, elevate depression risk in susceptible subjects. Consequently, extensive research has explored treatment strategies involving the endocrine system. Treatment guidelines recommend tri-iodothyronine augmentation for resistant depression, while allopregnanolone analogs have gained approval for postpartum depression, with ongoing investigations for broader depressive disorders. This book chapter will introduce the relationship between the endocrine system and depressive disorders, presenting clinical findings on neuroendocrinological treatments for depression.
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Affiliation(s)
- Seoyoung Yoon
- Department of Psychiatry, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Yong-Ku Kim
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea.
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Matteson KA, Valcin J, Raker CA, Clark MA. A randomized trial comparing the 52-mg levonorgestrel system with combination oral contraceptives for treatment of heavy menstrual bleeding. Am J Obstet Gynecol 2023; 229:532.e1-532.e13. [PMID: 37536486 DOI: 10.1016/j.ajog.2023.07.049] [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: 04/03/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND The levonorgestrel intrauterine system and combined oral contraceptives are the 2 most commonly used nonsurgical treatments for heavy menstrual bleeding in the United States. However, there are limited data on their relative effectiveness and on their impact on bleeding-specific quality of life. OBJECTIVE This study aimed to compare the effectiveness of the 52-mg levonorgestrel intrauterine system with that of combined oral contraceptives for improving quality of life among individuals who self-report heavy menstrual bleeding. We hypothesized that the levonorgestrel intrauterine system would be more effective than combined oral contraceptives at 6 and 12 months after treatment. STUDY DESIGN We conducted a pragmatic randomized trial of individuals who self-reported heavy menstrual bleeding. Individuals were eligible if they did not have contraindications to either the levonorgestrel intrauterine system or combined oral contraceptives and were determined to have a nonstructural cause of heavy menstrual bleeding. Eligible and consenting participants were randomly assigned in a 1:1 ratio to receive a 52-mg levonorgestrel intrauterine system or a monophasic 30- or 35-μg ethinyl estradiol-containing combined oral contraceptive. The main outcome was mean change in bleeding-related quality of life, measured by the 20-question Menstrual Bleeding Questionnaire (score range, 0-75) at 6 and 12 months. Differences in group means and confidence intervals for the Menstrual Bleeding Questionnaire score were computed by multivariable linear mixed-effects regression; 24 participants per group were needed to detect a 10-point difference in change in mean Menstrual Bleeding Questionnaire score between individuals treated with the levonorgestrel intrauterine system and those treated with combined oral contraceptives at each follow-up time point. RESULTS A total of 62 individuals were randomly assigned to treatment (n=29 allocated to levonorgestrel intrauterine system and n=33 allocated to combined oral contraceptives) and included in the intention-to-treat analyses; 19 of 29 received the levonorgestrel intrauterine system and 31 of 33 received combined oral contraceptives. Eleven percent identified as Black or African American and 44% identified as Hispanic or Latina. Participant characteristics were similar among study groups. Bleeding-related quality of life increased in both study arms, as reflected by a significant decrease in Menstrual Bleeding Questionnaire scores beginning at 6-week follow-up. In the main intention-to-treat analyses (n=62), there were no differences in mean change in Menstrual Bleeding Questionnaire scores at 6 months (difference=-2.5; 95% confidence interval, -10.0 to +5.0) or 12 months (difference=-1.1; 95% confidence interval, -8.7 to +6.5). Findings were similar in the subsets of participants with any follow-up visits (n=52) and who completed all follow-up visits (n=42). In the per-protocol analyses (n=47), a significantly greater decrease in Menstrual Bleeding Questionnaire score was observed in the levonorgestrel intrauterine system arm at 6 months after treatment (difference=-7.0; 95% confidence interval, -13.8 to -0.2) but not at 12 months (difference=-4.8; 95% confidence interval, -11.8 to 2.3) compared with the combined oral contraceptive arm. CONCLUSION No differences in change of bleeding-related quality of life were observed between the levonorgestrel intrauterine system and combined oral contraceptives at 6 or 12 months. Patients should be counseled that the levonorgestrel intrauterine system and combined oral contraceptives are both effective options for improving bleeding-related quality of life.
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Affiliation(s)
- Kristen A Matteson
- Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence, RI.
| | - Josie Valcin
- Warren Alpert Medical School of Brown University, Providence, RI
| | - Christina A Raker
- Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence, RI
| | - Melissa A Clark
- Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence, RI; Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI
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12
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Valencia-Cifuentes V, Cañas CA, Rivas JC. Major depression associated with a levonorgestrel-releasing intrauterine system mimicking frontotemporal dementia: a case report. Front Psychiatry 2023; 14:1266419. [PMID: 37779626 PMCID: PMC10535084 DOI: 10.3389/fpsyt.2023.1266419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
This case illustrates the adverse cognitive and affective effects associated with the use of an intrauterine hormonal contraceptive, which could be confused with symptoms of early onset dementia. We present a case of a 42-year-old woman diagnosed with seronegative spondyloarthropathy who subsequently developed anxiety and depressive symptoms after the implantation of a Levonorgestrel-Releasing Intrauterine System (LNG-IUS). Three years later, she began to experience memory and attentional failures, refractory pain, and severe depression. The progression of psychiatric symptoms led to a diagnosis of bipolar affective disorder and treatment with antidepressants and anxiolytics. Due to cognitive and psychiatric symptoms, autoimmune encephalitis was considered, but no improvement was shown with treatment. Early onset dementia was suspected, and a brain PET scan revealed frontal lobe hypometabolism. An adverse effect of LNG-IUS was considered; after its removal, mood and cognitive function improvements were observed. This case report emphasizes the importance of considering organic causes of unexplained psychiatric manifestations and highlights the potential impact of hormonal interventions on mental health.
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Affiliation(s)
- Valeria Valencia-Cifuentes
- Department of Neurology, Fundación Valle del Lili, Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Carlos A. Cañas
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
- Universidad ICESI, CIRAT: Centro de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Cali, Colombia
- Department of Rheumatology, Fundación Valle del Lili, Cali, Colombia
| | - Juan Carlos Rivas
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
- Department of Psychiatry, Fundación Valle del Lili, Cali, Colombia
- Department of Psychiatry, Universidad del Valle, Cali, Colombia
- Hospital Departamental Psiquiátrico, Universitario del Valle, Cali, Colombia
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Johansson T, Vinther Larsen S, Bui M, Ek WE, Karlsson T, Johansson Å. Population-based cohort study of oral contraceptive use and risk of depression. Epidemiol Psychiatr Sci 2023; 32:e39. [PMID: 37303201 PMCID: PMC10294242 DOI: 10.1017/s2045796023000525] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 05/01/2023] [Accepted: 05/10/2023] [Indexed: 06/13/2023] Open
Abstract
AIM Research on the effect of oral contraceptive (OC) use on the risk of depression shows inconsistent findings, especially in adult OC users. One possible reason for this inconsistency is the omission of women who discontinue OCs due to adverse mood effects, leading to healthy user bias. To address this issue, we aim to estimate the risk of depression that is associated with the initiation of OCs as well as the effect of OC use on lifetime risk of depression. METHODS This is a population-based cohort study based on data from 264,557 women from the UK Biobank. Incidence of depression was addressed via interviews, inpatient hospital or primary care data. The hazard ratio (HR) between OC use and incident depression was estimated by multivariable Cox regression with OC use as a time-varying exposure. To validate causality, we examined familial confounding in 7,354 sibling pairs. RESULTS We observed that the first 2 years of OC use were associated with a higher rate of depression compared to never users (HR = 1.71, 95% confidence interval [CI]: 1.55-1.88). Although the risk was not as pronounced beyond the first 2 years, ever OC use was still associated with an increased lifetime risk of depression (HR = 1.05, 95% CI: 1.01-1.09). Previous OC use were associated with a higher rate of depression compared to never users, with adolescent OC users driving the increased hazard (HR = 1.18, 95% CI: 1.12-1.25). No significant association were observed among adult OC users who had previously used OCs (HR = 1.00, 95% CI: 0.95-1.04). Notably, the sibling analysis provided further evidence for a causal effect of OC use on the risk of depression. CONCLUSIONS Our findings suggest that the use of OCs, particularly during the first 2 years, increases the risk of depression. Additionally, OC use during adolescence might increase the risk of depression later in life. Our results are consistent with a causal relationship between OC use and depression, as supported by the sibling analysis. This study highlights the importance of considering the healthy user bias as well as family-level confounding in studies of OC use and mental health outcomes. Physicians and patients should be aware of this potential risk when considering OCs, and individualized risk-benefit assessments should be conducted.
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Affiliation(s)
- T. Johansson
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
- Centre for Women’s Mental Health during the Reproductive Lifespan – Womher, Uppsala University, Uppsala, Sweden
| | - S. Vinther Larsen
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - M. Bui
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - W. E. Ek
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - T. Karlsson
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Å. Johansson
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
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14
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Galea LA, Lee BH, de leon RG, Rajah MN, Einstein G. Beyond sex and gender differences: The case for women's health research. PRINCIPLES OF GENDER-SPECIFIC MEDICINE 2023:699-711. [DOI: 10.1016/b978-0-323-88534-8.00045-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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