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Yang Q, Bränn E, Bertone- Johnson ER, Sjölander A, Fang F, Oberg AS, Valdimarsdóttir UA, Lu D. The bidirectional association between premenstrual disorders and perinatal depression: A nationwide register-based study from Sweden. PLoS Med 2024; 21:e1004363. [PMID: 38547436 PMCID: PMC10978009 DOI: 10.1371/journal.pmed.1004363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 02/19/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Premenstrual disorders (PMDs) and perinatal depression (PND) share symptomology and the timing of symptoms of both conditions coincide with natural hormonal fluctuations, which may indicate a shared etiology. Yet, there is a notable absence of prospective data on the potential bidirectional association between these conditions, which is crucial for guiding clinical management. Using the Swedish nationwide registers with prospectively collected data, we aimed to investigate the bidirectional association between PMDs and PND. METHODS AND FINDINGS With 1,803,309 singleton pregnancies of 1,041,419 women recorded in the Swedish Medical Birth Register during 2001 to 2018, we conducted a nested case-control study to examine the risk of PND following PMDs, which is equivalent to a cohort study, and transitioned that design into a matched cohort study with onward follow-up to simulate a prospective study design and examine the risk of PMDs after PND (within the same study population). Incident PND and PMDs were identified through clinical diagnoses or prescribed medications. We randomly selected 10 pregnant women without PND, individually matched to each PND case on maternal age and calendar year using incidence density sampling (N: 84,949: 849,482). We (1) calculated odds ratio (OR) and 95% confidence intervals (CIs) of PMDs using conditional logistic regression in the nested case-control study. Demographic factors (country of birth, educational level, region of residency, and cohabitation status) were adjusted for. We (2) calculated the hazard ratio (HR) and 95% CIs of PMDs subsequent to PND using stratified Cox regression in the matched cohort study. Smoking, BMI, parity, and history of psychiatric disorders were further controlled for, in addition to demographic factors. Pregnancies from full sisters of PND cases were identified for sibling comparison, which contrasts the risk within each set of full sisters discordant on PND. In the nested case-control study, we identified 2,488 PMDs (2.9%) before pregnancy among women with PND and 5,199 (0.6%) among controls. PMDs were associated with a higher risk of subsequent PND (OR 4.76, 95% CI [4.52,5.01]; p < 0.001). In the matched cohort with a mean follow-up of 7.40 years, we identified 4,227 newly diagnosed PMDs among women with PND (incidence rate (IR) 7.6/1,000 person-years) and 21,326 among controls (IR 3.8). Compared to their matched controls, women with PND were at higher risk of subsequent PMDs (HR 1.81, 95% CI [1.74,1.88]; p < 0.001). The bidirectional association was noted for both prenatal and postnatal depression and was stronger among women without history of psychiatric disorders (p for interaction < 0.001). Sibling comparison showed somewhat attenuated, yet statistically significant, bidirectional associations. The main limitation of this study was that our findings, based on clinical diagnoses recorded in registers, may not generalize well to women with mild PMDs or PND. CONCLUSIONS In this study, we observed a bidirectional association between PMDs and PND. These findings suggest that a history of PMDs can inform PND susceptibility and vice versa and lend support to the shared etiology between both disorders.
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Affiliation(s)
- Qian Yang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Emma Bränn
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Elizabeth R. Bertone- Johnson
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
| | - Arvid Sjölander
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Sara Oberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Unnur A. Valdimarsdóttir
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Donghao Lu
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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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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Wei S, Tang YY, Wang F, Wang Y, Geng X. Editorial: Neural circuits and neuroendocrine mechanisms of depression and premenstrual dysphoric disorder: towards precise targets for translational medicine and drug development, volume II. Front Psychiatry 2023; 14:1216689. [PMID: 37383611 PMCID: PMC10295715 DOI: 10.3389/fpsyt.2023.1216689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/16/2023] [Indexed: 06/30/2023] Open
Affiliation(s)
- Sheng Wei
- Experimental Center, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yi-Yuan Tang
- College of Health Solutions, Arizona State University, Tempe, AZ, United States
| | - Fushun Wang
- Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, China
| | - Yang Wang
- Department of Integrative Medicine, Xiangya Hospital of Central South, Changsha, China
| | - Xiwen Geng
- Experimental Center, Shandong University of Traditional Chinese Medicine, Jinan, China
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Eccles H, Sharma V. The association between premenstrual dysphoric disorder and depression: A systematic review. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2023. [DOI: 10.1016/j.jadr.2023.100504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
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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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Hou L, Chen L, Zhou R. Premenstrual syndrome is associated with an altered spontaneous electroencephalographic delta/beta power ratio across the menstrual cycle. Int J Psychophysiol 2022; 181:64-72. [PMID: 36029920 DOI: 10.1016/j.ijpsycho.2022.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/16/2022] [Accepted: 08/21/2022] [Indexed: 11/25/2022]
Abstract
Premenstrual syndrome is associated with altered spontaneous brain activity in the late luteal phase, but the fluctuation patterns of brain activity throughout the menstrual cycle have not been revealed. Furthermore, it is also unknown whether the altered spontaneous brain activity during the whole menstrual cycle is further associated with their habitual use of maladaptive emotion regulation strategies. Based on the two reasons, electroencephalogram data and cognitive emotion regulation questionnaire from 32 women with high premenstrual symptoms (HPMS) and 33 women with low premenstrual symptoms (LPMS) were measured in the late luteal and follicular phases. Delta power, theta power, beta power, and the slow/fast wave ratios (SW/FW, including theta/beta power ratio [TBR] and delta/beta power ratio [DBR]) were calculated using both fixed frequency bands and individually adjusted frequency bands (based on the individual alpha peak frequency). The results showed that for the frontal and central DBR, as assessed both with fixed and individualized frequency bands, there was no difference between the two phases of the LPMS group, whereas there was a difference between the two phases of the HPMS group with a higher DBR in the late luteal phase than in the follicular phase. Further correlation results revealed that for women with HPMS in the late luteal phase, the frontal and central DBR values, as assessed both with fixed and individualized frequency bands, were positively correlated with self-blame and rumination. Consequently, HPMS was characterized by a fluctuation across the menstrual cycle in the DBR, which was further associated with maladaptive emotion regulation.
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Affiliation(s)
- Lulu Hou
- Department of Psychology, Shanghai Normal University, Shanghai 200234, China; Department of Psychology, Nanjing University, Nanjing 210096, China
| | - Lirong Chen
- Department of Psychology, Nanjing University, Nanjing 210096, China; Department of Psychology, Suzhou University of Science and Technology, Suzhou 215009, China
| | - Renlai Zhou
- Department of Psychology, Nanjing University, Nanjing 210096, China; State Key Laboratory of Media Convergence Production Technology and Systems, Beijing 100803, China.
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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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Patterns of premenstrual syndrome and depression symptoms in Chinese female university students: Results of a latent profile analysis. J Affect Disord 2021; 293:64-70. [PMID: 34174472 DOI: 10.1016/j.jad.2021.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 06/05/2021] [Accepted: 06/13/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Premenstrual syndrome (PMS) and depression co-occur frequently; however, their relationship remains controversial. This study was conducted primarily to discern heterogeneous patterns of such co-occurring symptoms in Chinese female university students, using a latent profile analysis (LPA), a person-centered statistical approach. METHODS The PMS Scale and Beck Depression Inventory were used to examine self-reported PMS and depression symptoms in 701 Chinese female university students. LPA, multinomial logistical regression, and analyses of variance were adopted to investigate latent profiles and their validity. RESULTS The LPA results indicated that a four-class solution characterized by low symptoms (57.2%), predominantly PMS (11.3%), predominantly depression (23.7%), and combined PMS-depression (7.8%) patterns fitted the data best. Age, first menstrual experience, and personality factors were associated with differences in nonparallel profiles characteristic of menstrual attitude. LIMITATIONS Use of self-report measures can lead to response biases; the cross-sectional design at a single time point limits the examination of changes in symptom characteristics and members within the category over time; and the specific age group limits the generalizability of results. CONCLUSION These results confirm that PMS is independent from depression, rather than a variant of depression, and can be used to resolve the controversy regarding the relationship between PMS and depression. The current findings highlight the need for identifying women at high risk for PMS and depression, and promoting interventions individually tailored to their symptom presentations.
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Izakova L, Hlavacova N, Jezova D. Steroid stress hormone changes throughout the menstrual cycle: A rise in evening aldosterone concentration in early luteal phase precedes the symptoms of premenstrual syndrome. J Neuroendocrinol 2021; 33:e13043. [PMID: 34595778 DOI: 10.1111/jne.13043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 09/08/2021] [Accepted: 09/11/2021] [Indexed: 11/28/2022]
Abstract
There is still a lack of consistent evidence on dysregulation of steroid stress hormones cortisol and aldosterone in premenstrual syndrome (PMS). We aimed to test the hypothesis that, in healthy women, salivary aldosterone concentrations are higher in those with PMS compared to controls, particularly during the luteal phase of the menstrual cycle. In total, 99 female subjects (49 women with and 50 women without PMS) participated in a prospective non-interventional case-control study. Saliva sampling was performed in the follicular (day 8), early luteal (day 20) and late luteal phase (2 days before expected onset of bleeding) of the menstrual cycle in the morning and the evening. The results confirmed the hypothesis that salivary aldosterone concentrations are higher in women with PMS during the early luteal phase compared to controls (p < .01) in the evening. Early luteal phase aldosterone concentrations positively correlated with the frequency of premenstrual symptoms. Women with PMS exhibited a flatter morning to evening aldosterone slope compared to controls (p < .05). Morning and evening salivary cortisol concentrations were unchanged throughout the menstrual cycle in both groups of women. In conclusion, evening salivary aldosterone, but not cortisol concentrations, are increased in women with PMS during the early luteal phase compared to controls. Cortisol does not appear to be involved in the mechanisms contributing to the course of PMS. High evening salivary aldosterone in the early luteal phase may represent an important risk factor and could be of predictive value for the occurrence of premenstrual symptoms.
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Affiliation(s)
- Lubomira Izakova
- Faculty of Medicine, Department of Psychiatry, Comenius University and University Hospital Bratislava, Bratislava, Slovakia
| | - Natasa Hlavacova
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Daniela Jezova
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
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Chan JH, Lo C, Hsu CD, Chiu CC, Huang MC, Liao SC, Chen IM, Chen WY, Chen HC, Kuo PH. Premenstrual dysphoric symptoms and lifetime suicide experiences in patients with mood disorder. Gen Hosp Psychiatry 2021; 71:82-87. [PMID: 33965699 DOI: 10.1016/j.genhosppsych.2021.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Premenstrual dysphoric symptoms (PMDS) commonly co-occurred with mood disorders and correlated with suicide experiences in women. This study aims to examine the associations between PMDS and lifetime suicide experiences in patients with mood disorders. METHODS Participants were recruited from outpatient settings of two medical centers and one psychiatric hospital in Taiwan. Women aged 18-65 in non-acute state of major depressive disorder or bipolar affective disorder were recruited. PMDS and lifetime suicide experiences were defined by the Schedule for Affective Disorder and Schizophrenia-Lifetime. Lifetime suicide experiences were defined as no suicide experience, suicide plans only and suicide attempts. RESULTS A total of 383 women participated in this study (54.8% of them were diagnosed with major depressive disorder), and 13.8% were diagnosed with PMDS. The prevalence of patients with lifetime suicide plans only and lifetime suicide attempts were 15.9% and 39.7%, respectively. In the univariate analysis, PMDS was correlated with lifetime suicide experience. After controlling for covariates, PMDS was a risk indicator for lifetime suicide attempts (OR: 3.46, 95% CI: 1.43-8.38) but not for suicide plans only (OR: 0.93, 95% CI: 0.28-3.11). CONCLUSIONS PMDS correlated with lifetime suicide experiences in women with non-acute mood disorders. In particular, PMDS exhibited as an independent correlate for lifetime suicide attempts.
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Affiliation(s)
- Jen-Hui Chan
- Department of Psychiatry, National Taiwan University Hospital Hsin-Chu Branch, No.25, Lane 442, Sec.1, Jingguo Rd., Hsinchu City 300, Taiwan
| | - Chen Lo
- Department of Psychiatry, National Taiwan University Hospital, No.7 Chung San South Road, Taipei 10002, Taiwan
| | - Cheng-Dien Hsu
- Department of Psychosomatic Medicine, Taiwan Adventist Hospital, No.424, Sec. 2, Bade Rd., Songshan District, Taipei City 10556, Taiwan
| | - Chih-Chiang Chiu
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, No. 309, Songde Rd., Xinyi Dist., Taipei City 110, Taiwan; Department of Psychiatry, School of Medicine, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist., Taipei City 110, Taiwan
| | - Ming-Chyi Huang
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, No. 309, Songde Rd., Xinyi Dist., Taipei City 110, Taiwan
| | - Shih-Cheng Liao
- Department of Psychiatry, National Taiwan University Hospital, No.7 Chung San South Road, Taipei 10002, Taiwan; Department of Psychiatry, National Taiwan University Medical College, No.1 Jen Ai road section 1, Taipei 100233, Taiwan
| | - I-Ming Chen
- Department of Psychiatry, National Taiwan University Hospital, No.7 Chung San South Road, Taipei 10002, Taiwan
| | - Wen-Yin Chen
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, No. 309, Songde Rd., Xinyi Dist., Taipei City 110, Taiwan
| | - Hsi-Chung Chen
- Department of Psychiatry, National Taiwan University Hospital, No.7 Chung San South Road, Taipei 10002, Taiwan.
| | - Po-Hsiu Kuo
- Department of Psychiatry, National Taiwan University Hospital, No.7 Chung San South Road, Taipei 10002, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No. 17 Xuzhou Road, Taipei 100, Taiwan
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Yang Q, Sjölander A, Li Y, Viktorin A, Bertone-Johnson ER, Ye W, Fang F, Valdimarsdóttir UA, Lu D. Clinical indications of premenstrual disorders and subsequent risk of injury: a population-based cohort study in Sweden. BMC Med 2021; 19:119. [PMID: 34034729 PMCID: PMC8152351 DOI: 10.1186/s12916-021-01989-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 04/21/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Premenstrual disorders, including premenstrual syndrome and premenstrual dysphoric disorder, are suggested to be correlated with suicidal behavior and accidents in cross-sectional and retrospective studies. However, prospective data are still lacking. METHODS We performed a population-based cohort study including 1,472,379 Swedish women of reproductive age who were followed from 2001 to 2012. Within the cohort, we also performed a sibling analysis where we compared the rates of injury between full sisters. By linking to the Patient and the Prescribed Drug Registers, we identified 18,628 women with any clinical indications for premenstrual disorders in the cohort (population analysis) and 7674 women in the sibling analysis. Any injury, primarily suicidal behavior (completed suicide and suicide attempt) or accidents (e.g., fall and transportation accidents), was identified through the Patient and Causes of Death Registers as the primary outcome. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) of these outcomes among women with premenstrual disorders in both population and sibling analyses using multivariable Cox proportional hazards regression. RESULTS During a maximal follow-up of 12 years (mean 9.55 years), we identified 2390 women with premenstrual disorders with any injury; 216 through suicidal behavior and 2191 through accidents. Compared to women without premenstrual disorders, women with premenstrual disorders were at increased risk of any injury (HR 1.37, 95% CI 1.31-1.42), particularly suicidal behavior (HR 2.26, 95% CI 1.97-2.59) and accidents (HR 1.32, 95% CI 1.27-1.38). Such associations somewhat attenuated yet remained significant in the sibling analysis (HRs: 1.31 for any injury, 1.86 for suicidal behavior, and 1.29 for accidents). Additional adjustment for psychiatric comorbidities minimally altered the associations with any injury and accidents in both population and sibling analyses, whereas the association with suicidal behavior was considerably attenuated to non-significance in the sibling analysis. Such risks were particularly strong within 2 years after receiving the diagnosis of premenstrual disorders and were evident among women with premenstrual disorders with and without psychiatric comorbidities. CONCLUSIONS Our findings suggest that women with a clinical indication of premenstrual disorders are at increased subsequent risk of injury, particularly accidents within the first 2 years after diagnosis.
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Affiliation(s)
- Qian Yang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels Väg 12A, 17177, Stockholm, Sweden.
| | - Arvid Sjölander
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels Väg 12A, 17177, Stockholm, Sweden
| | - Yuchen Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels Väg 12A, 17177, Stockholm, Sweden
| | - Alexander Viktorin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels Väg 12A, 17177, Stockholm, Sweden
| | - Elizabeth R Bertone-Johnson
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA-01003, USA.,Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA-01003, USA
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels Väg 12A, 17177, Stockholm, Sweden
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Unnur A Valdimarsdóttir
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels Väg 12A, 17177, Stockholm, Sweden.,Center of Public Health Sciences, Faculty of Medicine, University of Iceland, IS-101, Reykjavík, Iceland.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA-02115, USA
| | - Donghao Lu
- Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA-02115, USA
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Kiesner J, Granger DA. A lack of consistent evidence for cortisol dysregulation in premenstrual syndrome/premenstrual dysphoric disorder. Psychoneuroendocrinology 2016; 65:149-64. [PMID: 26789492 DOI: 10.1016/j.psyneuen.2015.12.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 12/03/2015] [Accepted: 12/14/2015] [Indexed: 11/17/2022]
Abstract
Although decades of research has examined the association between cortisol regulation and premenstrual syndrome/premenstrual dysphoric disorder (PMS/PMDD), no review exists to provide a general set of conclusions from the extant research. In the present review we summarize and interpret research that has tested for associations between PMS/PMDD and cortisol levels and reactivity (n=38 original research articles). Three types of studies are examined: correlational studies, environmental-challenge studies, and pharmacological-challenge studies. Overall, there was very little evidence that women with and without PMS/PMDD demonstrate systematic and predictable mean-level differences in cortisol, or differences in cortisol response/reactivity to challenges. Methodological differences in sample size, the types of symptoms used for diagnosis (physical and psychological vs. only affective), or the type of cortisol measure used (serum vs. salivary), did not account for differences between studies that did and did not find significant effects. Caution is recommended before accepting the conclusion of null effects, and recommendations are made that more rigorous research be conducted, considering symptom-specificity, within-person analyses, and multiple parameters of cortisol regulation, before final conclusions are drawn.
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Affiliation(s)
- Jeff Kiesner
- Department of Psychology, Università Degli Studi di Padova, Italy.
| | - Douglas A Granger
- Institute for Interdisciplinary Salivary Bioscience Research (IISBR), Arizona State University, United States; Johns Hopkins University School of Nursing, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University School of Medicine, United States
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Yang J, Joe SH, Lee MS, Kim SH, Jung IK. Survey of premenstrual symptom severity and impairment in Korean adolescents: premenstrual dysphoric disorder, subthreshold premenstrual dysphoric disorder and premenstrual syndrome. Asia Pac Psychiatry 2014; 6:135-44. [PMID: 23857722 DOI: 10.1111/appy.12024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 10/28/2012] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The aims of the study were to examine the prevalence of premenstrual dysphoric disorder (PMDD), subthreshold PMDD and premenstrual syndrome (PMS) among adolescents, and to assess the nature of symptoms and the impact on daily life functions, especially for PMDD and subthreshold PMDD. METHODS A cross-sectional survey was conducted among adolescents from an urban area. Participants included 984 girls divided into the following four groups, using a premenstrual symptoms screening tool: PMDD, subthreshold PMDD, moderate/severe PMS and no/mild PMS. An Adolescent Mental Problem Questionnaire, Center for Epidemiological Studies-Depression Scale, revised Children's Manifest Anxiety Scale, and a menstrual information questionnaire were also used. RESULTS Sixty-three (6.76%) of the subjects met the criteria for PMDD and 58 (6.2%) were subthreshold PMDD. The subthreshold PMDD group included 79.3% who met the symptom criteria for PMDD, but their impairment was moderate, and 21.7% who were falling short by the number of symptoms for PMDD diagnosis, though reporting severe impairment. The symptom intensity and frequency of the subthreshold PMDD subjects were similar to those in subjects with PMDD. In these two groups, 69% had moderate to severe physical symptoms. Psychiatric problems, including depression and anxiety, were higher in the PMDD and subthreshold PMDD groups than in the moderate/severe PMS and no/mild PMS group. DISCUSSION In total, 20% of adolescents reported suffering from distressing premenstrual symptoms, and girls with PMDD and subthreshold PMDD were very similar in their symptom severity and characteristics. Prospective daily charting is needed to confirm the accurate diagnosis and management of PMDD.
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Affiliation(s)
- Jaewon Yang
- Department of Psychiatry, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea; Korea University Research Institute of Mental Health, Seoul, Korea
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Baskaran A, Cha DS, Powell AM, Jalil D, McIntyre RS. Sex differences in rates of obesity in bipolar disorder: postulated mechanisms. Bipolar Disord 2014; 16:83-92. [PMID: 24467470 DOI: 10.1111/bdi.12141] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 07/01/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The increased standardized mortality ratio (SMR) from cardiovascular disease (CVD) in women with bipolar disorder (BD), relative to men with BD and individuals of both sexes in the general population, provides the impetus to identify factors that contribute to the differential association of obesity with BD in women. METHODS We conducted a selective PubMed search of English-language articles published from September 1990 to June 2012. The key search terms were bipolar disorder and metabolic syndrome cross-referenced with gender, sex, obesity, diabetes mellitus, hypertension, and dyslipidemia. The search was supplemented with a manual review of relevant article reference lists. Articles selected for review were based on author consensus, the use of a standardized experimental procedure, validated assessment measures, and overall manuscript quality. RESULTS It is amply documented that adults with BD are affected by the metabolic syndrome at a rate higher than the general population. Women with BD, when compared to men with BD and individuals of both sexes in the general population, have higher rates of abdominal obesity. The course and clinical presentation of BD manifest differently in men and women, wherein women exhibit a higher frequency of depression predominant illness, a later onset of BD, more seasonal variations in mood disturbance, and increased susceptibility to relapse. Phenomenological factors can be expanded to include differences in patterns of comorbidity between the sexes among patients with BD. Other factors that contribute to the increased risk for abdominal obesity in female individuals with BD include reproductive life events, anamnestic (e.g., sexual and/or physical abuse), lifestyle, and iatrogenic. CONCLUSIONS A confluence of factors broadly categorized as broad- and sex-based subserve the increased rate of obesity in women with BD. It remains a testable hypothesis that the increased abdominal obesity in women with BD mediates the increased SMR from CVD. A clinical recommendation that emerges from this review is amplified attention to the appearance, or history, of factors that conspire to increase obesity in female patients with BD.
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Affiliation(s)
- Anusha Baskaran
- Centre for Neuroscience Studies, Queen's University, Kingston, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
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Klatzkin RR, Bunevicius A, Forneris CA, Girdler S. Menstrual mood disorders are associated with blunted sympathetic reactivity to stress. J Psychosom Res 2014; 76:46-55. [PMID: 24360141 PMCID: PMC3951307 DOI: 10.1016/j.jpsychores.2013.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 10/30/2013] [Accepted: 11/02/2013] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Few studies have directly compared women with a menstrually related mood disorder (MRMD) with women who have suffered from depression for stress reactivity phenotypes. It is unclear whether blunted responses to stress in women with a MRMD reflect a unique phenotype of MRMDs or may be explained by a history of depression. METHODS We assessed cardiovascular reactivity to stress in four groups: 1) Women with a MRMD without a history of depression (n=37); 2) women with a MRMD plus a history of depression (n=26); 3) women without a MRMD and without a history of depression (n=43); and 4) women without a MRMD but with a history of depression (n=20). RESULTS Women with a MRMD showed blunted myocardial (heart rate and cardiac index) reactivity to mental stress compared to non-MRMD women, irrespective of histories of depression. Hypo-reactivity to stress predicted greater premenstrual symptom severity in the entire sample. Women with a MRMD showed blunted norepinephrine and diastolic blood pressure stress reactivity relative to women with no MRMD, but only when no history of depression was present. Both MRMD women and women with depression histories reported greater negative subjective responses to stress relative to their non-MRMD and never depressed counterparts. CONCLUSION Our findings support the assertion that a blunted stress reactivity profile represents a unique phenotype of MRMDs and also underscore the importance of psychiatric histories to stress reactivity. Furthermore, our results emphasize the clinical relevance of myocardial hypo-reactivity to stress, since it predicts heightened premenstrual symptom severity.
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Affiliation(s)
| | - Adomas Bunevicius
- Department of Psychiatry, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Catherine A. Forneris
- Department of Psychiatry, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Susan Girdler
- Department of Psychiatry, University of North Carolina at Chapel Hill, North Carolina, USA
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Pilver CE, Libby DJ, Hoff RA. Premenstrual dysphoric disorder as a correlate of suicidal ideation, plans, and attempts among a nationally representative sample. Soc Psychiatry Psychiatr Epidemiol 2013; 48:437-46. [PMID: 22752111 PMCID: PMC3774023 DOI: 10.1007/s00127-012-0548-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 06/19/2012] [Indexed: 01/08/2023]
Abstract
PURPOSE Suicide is a major public health concern and a leading cause of death in the United States. Psychopathology is an established risk factor for non-fatal suicidal behavior; however, it is unclear whether premenstrual dysphoric disorder (PMDD), a psychiatric disorder specific to women, is correlated with these outcomes. The objective of this study was to determine if PMDD status was associated with suicidal ideation, plans, and attempts, independent of socio-demographic factors and psychiatric comorbidity. METHODS We conducted a secondary data analysis of 3,965 American women aged 18-40 who participated in the Collaborative Psychiatric Epidemiology Survey. Descriptive statistics and forward stepwise logistic regression modeling were performed using SUDAAN software. RESULTS The prevalence of non-fatal suicidal behaviors increased in a graded fashion according to PMDD status. Although the control for demographic characteristics and psychiatric comorbidity greatly attenuated the unadjusted association between PMDD and suicidal behaviors, women with PMDD remained significantly more likely than women with no premenstrual symptoms to report suicidal ideation (OR 2.22; 95% CI 1.40-3.53), plans (OR 2.27; 95% CI 1.20-4.28), and attempts (OR 2.10; 95% CI 1.08-4.08). Only the likelihood of suicidal ideation was significantly elevated among women with moderate/severe premenstrual syndrome (PMS; OR 1.49; 95% CI 1.17-1.88), compared to women with no premenstrual symptoms. CONCLUSIONS PMDD was strongly and independently associated with non-fatal suicidal behaviors among a nationally representative sample. These findings suggest that clinicians treating women with PMDD should assess and be vigilant for signs of non-fatal suicidal behavior, and that clinicians should evaluate and treat the premenstrual symptoms of women who express these behaviors.
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Affiliation(s)
- Corey E. Pilver
- Yale School of Public Health, Division of Biostatistics, Yale University, New Haven, CT 06510, USA
| | | | - Rani A. Hoff
- VISN 1 MIRECC, VA CT Healthcare System, West Haven, CT, USA,Department of Psychiatry, Yale University, New Haven, CT, USA
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Jeong HG, Ham BJ, Yeo HB, Jung IK, Joe SH. Gray matter abnormalities in patients with premenstrual dysphoric disorder: an optimized voxel-based morphometry. J Affect Disord 2012; 140:260-7. [PMID: 22381950 DOI: 10.1016/j.jad.2012.02.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 02/06/2012] [Accepted: 02/06/2012] [Indexed: 01/24/2023]
Abstract
BACKGROUND Although brain neurochemistry is thought to play a role in the development of premenstrual dysphoric disorder (PMDD), neuroimaging studies of PMDD are sparse. We examined the extent to which gray matter (GM) abnormalities were present in women with PMDD compared to healthy controls. METHODS 3.0T magnetic resonance imaging scans of 15 women with PMDD and 15 healthy controls were compared using optimized voxel-based morphometry (VBM) analysis. A regression analysis was used to assess the relationship between GM density and PMDD-symptom severity. RESULTS Our results showed significantly increased GM density in the hippocampal cortex and significantly decreased GM density in the parahippocampal cortex among women with PMDD compared to healthy controls. However, these GM abnormalities were not significantly associated with the severity of PMDD. LIMITATION Our inferences of the relationships between structural alterations and PMDD are drawn from a small sample, which may have increased the likelihood of type I error. CONCLUSIONS GM abnormalities in limbic and paralimbic cortices were found to be associated with the pathophysiology of PMDD. Etiology of PMDD is likely related to emotional processing and self-regulation. Our findings provide a basis of neurobiological model for PMDD.
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Affiliation(s)
- Hyun-Ghang Jeong
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
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Ogebe O, Abdulmalik J, Bello-Mojeed MA, Holder N, Jones HA, Ogun OO, Omigbodun O. A comparison of the prevalence of premenstrual dysphoric disorder and comorbidities among adolescents in the United States of America and Nigeria. J Pediatr Adolesc Gynecol 2011; 24:397-403. [PMID: 22099733 DOI: 10.1016/j.jpag.2011.07.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 07/16/2011] [Accepted: 07/19/2011] [Indexed: 10/15/2022]
Abstract
STUDY OBJECTIVE Premenstrual dysphoric disorder (PMDD) often starts in adolescence, but there are limited data on its prevalence. The specific aims of this study were to (1) describe the prevalence of PMDD in adolescents presenting to clinics in the midwestern United States and 2 Nigerian cities, (2) identify cultural differences, and (3) screen for comorbidities. DESIGN A cross-sectional survey was conducted among adolescents attending outpatient clinics in the 3 sites. Study participants provided demographic information and completed a modified version of the Premenstrual Symptoms Screening Tool. They also completed the modified Mini International Neuropsychiatric Interview screen for comorbid psychiatric conditions. RESULTS Five-hundred thirty-seven patients participated in the study. The participants were between 13-21 years old (mean [SD] =16.9 [2.02] years). The overall prevalence of PMDD was 4.1% (Maiduguri, Nigeria 6.5%; Lagos, Nigeria 3.1%; and 2.9% in Akron, United States). The differences were not statistically significant (P = .167). The prevalence of moderate to severe premenstrual syndrome ranged from 12.4%-16.3% among the 3 sites, with an overall prevalence of 14.5%. There was a significantly higher prevalence of other mood disorders in Akron (19.3%) compared to the Nigerian sites (P < .001.). This difference across cultures was statistically significant. CONCLUSIONS Premenstrual dysphoric disorder is prevalent across different cultures. It is a chronic condition that causes significant morbidity among adolescents. There is a need for simple diagnostic methods for early detection and evidence-based management guidelines.
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Affiliation(s)
- Ori Ogebe
- Akron Children's Hospital, Akron, OH, USA.
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Forrester-Knauss C, Zemp Stutz E, Weiss C, Tschudin S. The interrelation between premenstrual syndrome and major depression: results from a population-based sample. BMC Public Health 2011; 11:795. [PMID: 21992230 PMCID: PMC3209462 DOI: 10.1186/1471-2458-11-795] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 10/12/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research about the relationship between premenstrual syndrome (PMS) and major depression is limited. This study examined the relationship between moderate to severe PMS and major depression in a population-based sample of women of reproductive age. The objectives of the study were to assess the association between premenstrual syndrome and major depression, to analyse how PMS and major depression differ and to characterise the group of women who report both PMS and major depression. METHODS Data were obtained from the Swiss Health Survey 2007. Included in the analysis was data from women under the age of 55 without hysterectomy and who answered the questions on PMS symptoms. The population-based sample consisted of 3518 women. Weighted prevalence rates were calculated and relative risk ratios for PMS, major depression and women who reported both PMS and major depression, were calculated with logistic multinominal logit regression. RESULTS The prevalence of major depression was 11.3% in women screening positive for moderate PMS and 24.6% in women screening positive for severe PMS. Compared to women without any of these conditions, women who reported moderate to severe alcohol consumption had a lower risk for PMS. Women reporting use of antidepressants, and use of oral contraceptives had a higher risk for major depression compared to women without any of these conditions. Women reporting work dissatisfaction had a higher risk for PMS. A higher relative risk to report both PMS and major depression compared to women without PMS or major depression was related to factors such as high psychological distress, low mastery, psychotropic drug consumption, and low self-rated health. CONCLUSIONS The results suggested that women who suffer from both PMS and major depression are more impaired compared to women with only one disorder. The results further indicated that PMS and major depression are different disorders that can, however, co-occur.
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Affiliation(s)
- Christine Forrester-Knauss
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss TPH), Socinstr, 57, 4051 Basel, Switzerland.
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Histories of major depression and premenstrual dysphoric disorder: Evidence for phenotypic differences. Biol Psychol 2010; 84:235-47. [PMID: 20138113 DOI: 10.1016/j.biopsycho.2010.01.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Revised: 01/20/2010] [Accepted: 01/28/2010] [Indexed: 11/21/2022]
Abstract
This study examined unique versus shared stress and pain-related phenotypes associated with premenstrual dysphoric disorder (PMDD) and prior major depressive disorder (MDD). Sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal (HPA)-axis measures were assessed at rest and during mental stress, as well as sensitivity to cold pressor and tourniquet ischemic pain tasks in four groups of women: (1) non-PMDD with no prior MDD (N=18); (2) non-PMDD with prior MDD (N=9); (3) PMDD with no prior MDD (N=17); (4) PMDD with prior MDD (N=10). PMDD women showed blunted SNS responses to stress compared to non-PMDD women, irrespective of prior MDD; while women with prior MDD showed exaggerated diastolic blood pressure responses to stress versus never depressed women, irrespective of PMDD. However, only in women with histories of MDD did PMDD women have lower cortisol concentrations than non-PMDD women, and only in non-PMDD women was MDD associated with reduced cold pressor pain sensitivity. These results suggest both unique phenotypic differences between women with PMDD and those with a history of MDD, but also indicate that histories of MDD may have special relevance for PMDD.
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Cunningham J, Yonkers KA, O'Brien S, Eriksson E. Update on research and treatment of premenstrual dysphoric disorder. Harv Rev Psychiatry 2009; 17:120-37. [PMID: 19373620 PMCID: PMC3098121 DOI: 10.1080/10673220902891836] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Many women in their reproductive years experience some mood, behavioral. or physical symptoms in the week prior to menses. Variability exists in the level of symptom burden in that some women experience mild symptoms, whereas a small minority experience severe and debilitating symptoms. For an estimated 5%-8% of premenopausal women, work or social functioning are affected by severe premenstrual syndrome. Many women in this group meet diagnostic criteria for premenstrual dysphoric disorder (PMDD). Among women who suffer from PMDD, mood and behavioral symptoms such as irritability, depressed mood, tension, and labile mood dominate. Somatic complaints, including breast tenderness and bloating, also can prove disruptive to women's overall functioning and quality of life. Recent evidence suggests that individual sensitivity to cyclical variations in levels of gonadal hormones may predispose certain women to experience these mood, behavioral, and somatic symptoms. Treatments include: antidepressants of the serotonin reuptake inhibitor class, taken intermittently or throughout the menstrual cycle; medications that suppress ovarian cyclicity; and newer oral contraceptives with novel progestins.
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Affiliation(s)
- Joanne Cunningham
- Department of Psychiatry, Yale University, New Haven, CT 06510, USA.
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Freeman EW. Effects of antidepressants on quality of life in women with premenstrual dysphoric disorder. PHARMACOECONOMICS 2005; 23:433-44. [PMID: 15896095 DOI: 10.2165/00019053-200523050-00003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
This review examines the effects of antidepressant medications on premenstrual dysphoric disorder (PMDD) and the diminished quality of life (QOL) that accompanies the disorder. PMDD is a chronic condition in women that emerges in the second half of the menstrual cycle and remits during the menstrual period. The affective and behavioural symptoms of PMDD adversely affect functioning and QOL to a disabling degree, particularly in the domains of family and personal relationships, work productivity and social activities. The serotonergic antidepressants, specifically the selective serotonin reuptake inhibitors (SSRIs), are effective for PMDD. Continuous and luteal-phase dosing regimens with SSRIs are similarly effective and well tolerated. Treatment of PMDD with a serotonergic antidepressant significantly improves functioning and QOL in all studies that have systematically examined QOL issues in this disorder. Although the data show that PMDD is effectively treated with serotonergic antidepressants and that functional impairment that accompanies the disorder is also improved with treatment, the social and economic burden of PMDD continues to be widely unrecognised. Greater awareness of the effectiveness of treatments and reliable measures of the direct and indirect healthcare costs of the disorder when it remains untreated are needed.
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Affiliation(s)
- Ellen W Freeman
- Department of Obstetrics/Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania 19104-5509, USA.
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Pritham UA. Managing PMS & PMDD. Exploring new treatment options. AWHONN LIFELINES 2002; 6:430-7. [PMID: 12420386 DOI: 10.1177/1091592302238929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ursula A Pritham
- Family Practice Center, Eastern Maine Medical Center in Bangor, ME, USA
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Women's health literaturewatch. JOURNAL OF WOMEN'S HEALTH & GENDER-BASED MEDICINE 2002; 11:191-5. [PMID: 11975867 DOI: 10.1089/152460902753645335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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