Oral contraceptives and depressive symptomatology: biologic mechanisms

New perspectives on 'Breathomics': metabolomic profiling of non-volatile organic compounds in exhaled breath using DI-FT-ICR-MS

Breath analysis offers tremendous potential for diagnostic approaches, since it allows for easy and non-invasive sample collection. "Breathomics" as one major research field comprehensively analyses the metabolomic profile of exhaled breath providing insights into various (patho)physiological processes. Recent research, however, primarily focuses on volatile compounds. This is the first study that evaluates the non-volatile organic compounds (nVOCs) in breath following an untargeted metabolomic approach. Herein, we developed an innovative method utilizing a filter-based device for metabolite extraction. Breath samples of 101 healthy volunteers (female n = 50) were analysed using DI-FT-ICR-MS and biostatistically evaluated. The characterisation of the non-volatile core breathome identified more than 1100 metabolites including various amino acids, organic and fatty acids and conjugates thereof, carbohydrates as well as diverse hydrophilic and lipophilic nVOCs. The data shows gender-specific differences in metabolic patterns with 570 significant metabolites. Male and female metabolomic profiles of breath were distinguished by a random forest approach with an out-of-bag error of 0.0099. Additionally, the study examines how oral contraceptives and various lifestyle factors, like alcohol consumption, affect the non-volatile breathome. In conclusion, the successful application of a filter-based device combined with metabolomics-analyses delineate a non-volatile breathprint laying the foundation for discovering clinical biomarkers in exhaled breath.

A Perspective on Hormonal Contraception Usage in Central Nervous System Injury

Naturally occurring life stages in women are associated with changes in the milieu of endogenous ovarian hormones. Women of childbearing age may be exposed to exogenous ovarian hormone(s) because of their use of varying combinations of estrogen and progesterone hormones-containing oral contraceptives (OC; also known as "the pill"). If women have central nervous system (CNS) injury such as spinal cord injury (SCI) and traumatic brain injury (TBI) during their childbearing age, they are likely to retain their reproductive capabilities and may use OC. Many deleterious side effects of long-term OC use have been reported, such as aberrant blood clotting and endothelial dysfunction that consequently increase the risk of myocardial infarction, venous thromboembolism, and ischemic brain injury. Although controversial, studies have suggested that OC use is associated with neuropsychiatric ramifications, including uncontrollable mood swings and poorer cognitive performance. Our understanding about how the combination of endogenous hormones and OC-conferred exogenous hormones affect outcomes after CNS injuries remains limited. Therefore, understanding the impact of OC use on CNS injury outcomes needs further investigation to reveal underlying mechanisms, promote reporting in clinical or epidemiological studies, and raise awareness of possible compounded consequences. The goal of the current review is to discuss the impacts of CNS injury on endogenous ovarian hormones and vice-versa, as well as the putative consequences of exogenous ovarian hormones (OC) on the CNS to identify potential gaps in our knowledge to consider for future laboratory, epidemiological, and clinical studies.

Oral contraceptives in the central nervous system: Basic pharmacology, methodological considerations, and current state of the field

Millions of women around the world use combined oral contraceptives (OCs), yet surprisingly little is known about their central nervous system (CNS) effects. This article provides a short overview of the basic pharmacology of OCs, emphasizing features that may be relevant to understanding their effects in the CNS. Historical and recent findings from studies of cognitive function, mood, and negative affect (depressive changes under OC use) are then reviewed. We also present data from an archival dataset from our own laboratory in which we explore dysphoric changes in women using four generations of contraceptive progestins. Current data in the field are consistent with a modest effect of OC use on CNS variables, but conclusions based on current findings must be made very cautiously because of multiple methodological issues in many published studies to date, and inconsistencies in the findings. Directions for future research over the next 10 years are suggested. (150 words).

Psychological Aspects of Contraception, Unintended Pregnancy, and Abortion

The knowledge of important biopsychosocial factors linking women's reproductive health and mental health is increasing. This review focuses on psychological aspects of contraception, unintended pregnancy, and abortion because these are common reproductive health experiences in U.S. women's lives. This review addresses the mental-health antecedents and consequences of these experiences, mostly focusing on depression and depressive symptoms before and after unintended pregnancy and contraception. As mental-health antecedents, depressive symptoms predict contraceptive behaviors that lead to unintended pregnancy, and mental-health disorders have been associated with having subsequent abortions. In examining the mental-health consequences, most sound research does not find abortion or contraceptive use to cause mental-health problems. Consequently, evidence does not support policies based on the notion that abortion harms women's mental health. Nevertheless, the abortion-care setting may be a place to integrate mental-health services. In contrast, women who have births resulting from unintended pregnancies may be at higher risk of postpartum depression. Social policies (e.g., paid maternity leave, subsidized child care) may protect women from mental-health problems and stress of unplanned children interrupting employment, education, and pre-existing family care responsibilities.

Women's mental health clinic: a naturalistic description of the population attended in the San Diego VA Health Care System during a one year period

BACKGROUND

Due to specific gender predispositions to present certain illnesses, increasing incorporation of women in the U.S. military system represents an important challenge to both medical and mental health providers. The aim of this report is to describe the main characteristics of the population attended in a mental health women's clinic at the San Diego Veterans Administration (VA) health care system.

METHOD

Present study is a comprehensive clinical report based on a retrospective analysis of data. The authors searched the San Diego VA Health Care database to find the main epidemiological and clinical characteristics of the population attended during a one year period. Epidemiological and clinical features of the sample are presented. Authors also describe, using clinical examples, the most important psychopathological expressions.

RESULTS

The most prevalent psychiatric diagnosis was major depressive disorder (n=28; 19.51%) followed by dysthymic disorder (n=8; 19.51%) and bipolar disorder (n=3; 7.31%). Authors discuss the importance of three variables: social isolation, quality of adaptive mechanisms and the role of self-stigmatization as crucial factors related to patient's clinical outcomes.

LIMITATIONS

The main limitation of this review derives from its naturalistic and descriptive methodology.

CONCLUSIONS

The majority of patients treated in our clinic experience some type of affective disorder. Main factors associated to recovery are: social integration and spiritual support, utilization of mature defense mechanisms and upper-level coping strategies and psycho-educational interventions directed to prevent self stigmatization. Clinicians should be aware of these factors in order to promote "upper-level coping strategies".

Low dose oral contraceptives and quality of life

This study investigated the effects of a low dose oral contraceptive (OC) (Mercilon) on women's satisfaction and quality of life based on a detailed questionnaire. A total of 614 first-time users of oral contraceptives were enrolled by 102 gynecologists for a treatment period of > or = 4 months. The Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) was filled in both before and during pill intake. The total quality of life score was significantly increased under OC intake. In contrast to older preparations, modern low dose OCs appear to act favorably on a number of psychological parameters, thus increasing satisfaction with various aspects of daily life and, consequently, improving quality of life.

Oestrogens and psychological well-being

The last decade has seen increased interest in the role of hormones, including oestrogens, not only in regulating growth, sexual development and reproduction but in maintaining a sense of psychological well-being. Episodes of change in oestrogen levels, whether increasing or decreasing, are high-risk periods for the emergence of psychological symptoms in some women. This may be due to a 'kindling effect' for women with previous psychological disturbance, an effect on circadian rhythm activity and therefore altered neurovegetative functions, or an effect on central rhythmic functioning between the hypothalamus and the cerebral cortex, all mediated by effects on neurotransmitter systems. Data supporting these hypotheses come from animal studies as well as converging research in several areas including the study of psychological side-effects of oral contraceptives, the study of mood and cognitive disturbances related to the menstrual cycle, the studies of states of hormonal change such as pregnancy and the menopause and, of course, studies of women with psychiatric disorders such as major depression, seasonal affective disorder and dementia. Improvement in such symptoms via hormonal therapies or other interventions will probably lead to better quality of life for women and may actually impede the deterioration associated with ageing and certain medical illnesses. Current data support a relationship between oestrogen and psychological well-being.

Mood disorders and menopause

Studies of depressive symptoms in menopausal women indicate that menopause is not associated with increased rates of depression, although mild mood and anxiety symptoms may occur in the few years prior to menopause. Women with previous affective disorders that are cyclic or that are associated with reproductive events may be at increased risk for depression at menopause. Because women presenting to menopause clinics are more likely to have affective disorders, the efficacy of estrogen for enhancing mood is an important question. Although some researchers suggest that estrogens have proven mood-elevating and antidepressant properties, others caution that the psychologic benefits of HRT deserve more systematic study before conclusions can be made. It has been suggested that minor psychologic symptoms at menopause or psychologic symptoms accompanied by vasomotor symptoms warrant a trial of HRT before considering psychotropic medication. If the psychologic symptoms do not respond to HRT, are not accompanied by vasomotor symptoms, or are clinically severe, antidepressant medication should be considered first or in addition to HRT. The psychologic effects of progesterone and androgens are less extensively studied than those of estrogen, and further research is needed.

Serotonin and gender-specific psychiatric disorders

The serotonergic system has been linked to the etiology of several, albeit disparate, psychiatric disorders. The accumulation of many lines of evidence support the view that there are gender differences in the serotonergic system in humans. It is further proposed that a gender differentiated serotonergic system acts as the nidus for the development of gender-specific psychiatric disorders. Depression, anxiety and eating disorders are largely seen in females, whereas alcoholism, aggressivity and suicide predominate in males. Evidence from both animal and human studies suggesting that the serotonergic system mediates between social-environmental experience and biological states is presented and reviewed. A reconceptualization of the serotonergic system as a gender-specific psychobiological interface is proposed. (Int J Psych Clin Prac 1997; 1: 3-13).

Use of a monophasic, low-dose oral contraceptive in relation to mental functioning

The objective of the study was to evaluate the effect of Minulet, a new low-dose oral contraceptive on mood in two groups and to compare the effect with a control group of women not taking oral contraceptives (OC). The women participating were between 16 and 45 years of age. They completed the Amsterdam Mood Questionnaire (AMQ) and the Sickness Impact Profile (SIP) three times. They were filled in before treatment started, after taking Minulet for one month and then again after three months. The questionnaires were filled in by a group of 200 women who had not taken OC before (starters), and by a second group of 370 women who were already taking OC (switchers). A group of 140 women who did not use any OC during the study served as a control group. These women also filled in the same questionnaires, both at the start, and after one and three months. As far as the AMQ was concerned, the switchers appeared in the initial measurement to have significantly higher scores (that is to say, a worse mood) for "tiredness", "depression", "moodiness", "anxiety" and "anger", than those of the starters and the control group. Moreover, the switchers had reduced scores (that is to say, an improved mood) on the AMQ-scales during their use of Minulet compared to their initial use of oral contraceptives. The scores of the starters and the control group on the AMQ-scales remained unchanged on all three measurements. It can be concluded from this that these groups felt as well as they did before.(ABSTRACT TRUNCATED AT 250 WORDS)

The ability of antidepressant drugs to desensitize beta-receptors is inversely correlated with their clinical potency

The relative clinical potencies of a range of antidepressant drugs and their relative ability to desensitize beta-adrenergic receptors were compiled from published sources and found to be inversely correlated. This findings strongly suggest that desensitization of beta-receptors is not responsible for the clinical effects of antidepressants. This conclusion is supported by a discussion of the effects of steroid hormones on beta-receptors.

Oral contraceptives and depression: impact, prevalence and cause

One million American adolescents are currently using oral contraceptives. Sixty percent of those beginning the pill discontinue its use within a year. Concern that mood change might be contributing to the decision to stop the pill prompted a review of the literature on the association between oral contraceptive use and depression. Trends in adolescent pregnancy, contraceptive use, and compliance are discussed in the first section. In the second, 12 clinical studies are analyzed. Because there are no studies of mood change and oral contraceptive use in adolescents, some data from adults are presented. Biochemical theories to explain an association between oral contraceptive use and depression are discussed in section three. Nine of the 12 clinical studies reported depression in 16-56% of women using oral contraceptives. Three studies found no association between oral contraceptive use and depression. The major problems found in the clinical trials were selection bias, poor assessment of pre-therapeutic mood state and unclear definition or measurement of depression. Current biochemical research suggests that oral contraceptives induce tryptophan oxygenase, which leads to pyridoxine deficiency in some women. However, the use of pyridoxine to prevent or treat depression in women taking oral contraceptives requires further study.

Adverse psychiatric reactions to modern medication

From this survey it will be apparent that many psychiatric reactions to drugs are largely caused by their direct toxic actions or from combinations of drugs. As such, they are often dose related, although age and slow speed of detoxification will increase the risk of patients developing delirium, hallucinations, sleep disturbances, anxiety etc. Similar toxic reactions can also occur when drugs to which a patient has developed some measure of tolerance are abruptly withdrawn. In this context the effects of drugs upon patterns of sleep may be important determinants of adverse withdrawal symptoms. In contrast are the reactions which resemble one or other of the functional psychoses. In these patients it appears that a past history of an affective or schizophrenic psychosis is the best predictor of a similar illness being precipitated by a particular drug. Nonetheless, with substances like reserpine and cycloserine there is good reason for thinking that, given a sufficient quantity, practically any patient can develop an adverse psychiatric reaction.