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Kim H, Yoo J, Han K, Park MJ, Kim HS, Baek J, Jeon HJ. Female reproductive factors are associated with the risk of newly diagnosed bipolar disorder in postmenopausal women. J Psychiatr Res 2022; 153:82-89. [PMID: 35809405 DOI: 10.1016/j.jpsychires.2022.06.051] [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: 12/20/2021] [Revised: 05/13/2022] [Accepted: 06/24/2022] [Indexed: 11/27/2022]
Abstract
Changes in the levels of female sex hormones are associated with mood disorders in middle-aged women. This study investigated the association between female reproductive factors and the development of newly diagnosed bipolar disorder (BD). We used a South Korean nationwide medical records database. Postmenopausal women aged 40 or older who underwent health examinations were identified and followed for the occurrence of BD. We identified female reproductive factors including the age at menarche and menopause, parity, history of breastfeeding, oral contraceptive (OC) use, and hormone therapy (HT), and investigated their association with the occurrence of newly diagnosed BD. During an average of 8.32 years (SD 0.83) of follow-up, the incidence of BD was 0.50 per 1000 person-years in postmenopausal women. Compared to women with menopause at an age of 40 years or younger, those with menopause at an age of 45 years or older showed decreased risks of BD. Compared to women who had never breastfed, those who had breastfed for more than 12 months showed a decreased risk of BD. Compared to women who never received HT, those who received HT showed an increased risk of BD in a time-dependent manner. Among postmenopausal women, later menopause and breastfeeding for more than one year were associated with a decreased risk of BD occurrence, and receiving HT was associated with an increased risk.
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Affiliation(s)
- Hyewon Kim
- Department of Psychiatry, Hanyang University Hospital, Seoul, South Korea
| | - Juhwan Yoo
- Department of Biomedicine & Health Science, The Catholic University of Korea, Seoul, South Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
| | - Mi Jin Park
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hyun Soo Kim
- Department of Psychiatry, Dong-A University Hospital, Busan, South Korea
| | - Jihyun Baek
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Health Sciences & Technology, Department of Medical Device Management & Research, and Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea.
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2
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Aragno E, Fagiolini A, Cuomo A, Paschetta E, Maina G, Rosso G. Impact of menstrual cycle events on bipolar disorder course: a narrative review of current evidence. Arch Womens Ment Health 2022; 25:257-266. [PMID: 35237876 DOI: 10.1007/s00737-022-01217-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/20/2022] [Indexed: 11/02/2022]
Abstract
Several lines of research suggest that reproductive-related hormonal events may affect the course of bipolar disorder in some women. However, data on associations between bipolar disorder and menarche, menstrual cycle, and menopause are mixed. This article reviews the literature on the potential effects of menarche, menstrual cycle, and menopause on bipolar disorder.A narrative review of published articles on bipolar disorder and menstrual cycle events was conducted. The primary outcome assessed was the impact of menarche, menstrual cycle and menopause on the course of bipolar illness. Databases searched were PubMed, Ovid, Scopus, PsycINFO, Medline, and Cochrane Libraries from inception to August 2021.Twenty-two studies were identified and included in the narrative synthesis. Research suggested that a subset of women with bipolar disorder are vulnerable to the impact of menstrual cycle events. Menarche seems to be associated with age at onset of bipolar illness especially in case of bipolar disorder type I and the specific age at menarche may predict some clinical features of the disorder. Menstrual cycle likely affects the course of bipolar disorder but the pattern of mood variability is not clear. Menopause appears to be not only a period of vulnerability to mood alteration, especially depressive episodes, and impairment of quality of life, but also a potential trigger of bipolar illness onset.The impact of menarche, menstrual cycle, and menopause on bipolar disorder is largely understudied. Preliminary evidence suggests that a subset of women with bipolar disorder may have their mood shifts affected by menstrual cycle events, with different patterns depending on the type of bipolar disorder also. Further researches are needed to deep the impact of menarche, menstrual cycle, and menopause on bipolar illness.
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Affiliation(s)
- Elena Aragno
- Department of Neurosciences "Rita Levi Montalcini", University of Torino, Turin, Italy
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena, Siena, Italy
| | - Alessandro Cuomo
- Department of Molecular Medicine, University of Siena, Siena, Italy
| | | | - Giuseppe Maina
- Department of Neurosciences "Rita Levi Montalcini", University of Torino, Turin, Italy.,Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Torino, Italy
| | - Gianluca Rosso
- Department of Neurosciences "Rita Levi Montalcini", University of Torino, Turin, Italy. .,Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Torino, Italy.
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3
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Musial N, Ali Z, Grbevski J, Veerakumar A, Sharma P. Perimenopause and First-Onset Mood Disorders: A Closer Look. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2021; 19:330-337. [PMID: 34690602 DOI: 10.1176/appi.focus.20200041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Perimenopause is often a time of social, emotional, and physical change. Various factors contribute to the development of mood disorders during this time. There is a known association among women with previous history of major depressive disorder or bipolar disorder and relapse during the menopausal transition. First-onset mood disorders during this time have been less studied. A literature review in PsycInfo Ovid of records pertaining to first-onset mood disorders during perimenopause showed that this multifactorial process involves hormonal fluctuations, with estrogen being a key player. In addition, vasomotor symptoms, previous negative life events, and socioeconomic status were found to contribute to first-onset mood disorders during perimenopause. Treatment options include established medication regimens for psychiatric conditions; however, hormone therapy also has proven beneficial for this patient population. Further research, particularly on bipolar disorder, is needed to develop a clear association between perimenopause and first-onset mood disorders.
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Affiliation(s)
- Natalie Musial
- Department of Psychiatry, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Zinnia Ali
- Department of Psychiatry, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Jennifer Grbevski
- Department of Psychiatry, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Ashan Veerakumar
- Department of Psychiatry, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Priya Sharma
- Department of Psychiatry, Schulich School of Medicine and Dentistry, London, Ontario, Canada
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4
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Rehbein E, Hornung J, Sundström Poromaa I, Derntl B. Shaping of the Female Human Brain by Sex Hormones: A Review. Neuroendocrinology 2021; 111:183-206. [PMID: 32155633 DOI: 10.1159/000507083] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/09/2020] [Indexed: 12/26/2022]
Abstract
Traditionally sex hormones have been associated with reproductive and developmental processes only. Since the 1950s we know that hormones can have organizational effects on the developing brain and initiate hormonal transition periods such as puberty. However, recent evidence shows that sex hormones additionally structure the brain during important hormonal transition periods across a woman's life including short-term fluctuations during the menstrual cycle. However, a comprehensive review focusing on structural changes during all hormonal transition phases of women is still missing. Therefore, in this review structural changes across hormonal transition periods (i.e., puberty, menstrual cycle, oral contraceptive intake, pregnancy and menopause) were investigated in a structured way and correlations with sex hormones evaluated. Results show an overall reduction in grey matter and region-specific decreases in prefrontal, parietal and middle temporal areas during puberty. Across the menstrual cycle grey matter plasticity in the hippocampus, the amygdala as well as temporal and parietal regions were most consistently reported. Studies reporting on pre- and post-pregnancy measurements revealed volume reductions in midline structures as well as prefrontal and temporal cortices. During perimenopause, the decline in sex hormones was paralleled with a reduction in hippocampal and parietal cortex volume. Brain volume changes were significantly correlated with estradiol, testosterone and progesterone levels in some studies, but directionality remains inconclusive between studies. These results indicate that sex hormones play an important role in shaping women's brain structure during different transition periods and are not restricted to specific developmental periods.
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Affiliation(s)
- Elisa Rehbein
- Department of Psychiatry and Psychotherapy, Innovative Neuroimaging, University of Tübingen, Tübingen, Germany,
| | - Jonas Hornung
- Department of Psychiatry and Psychotherapy, Innovative Neuroimaging, University of Tübingen, Tübingen, Germany
| | | | - Birgit Derntl
- Department of Psychiatry and Psychotherapy, Innovative Neuroimaging, University of Tübingen, Tübingen, Germany
- Werner Reichardt Centre for Integrative Neuroscience, University of Tübingen, Tübingen, Germany
- Lead Graduate School, University of Tübingen, Tübingen, Germany
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5
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Antipsychotic effects of sex hormones and atypical hemispheric asymmetries. Cortex 2020; 127:313-332. [DOI: 10.1016/j.cortex.2020.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 02/27/2020] [Accepted: 02/29/2020] [Indexed: 12/16/2022]
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6
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Raglan GB, Schulkin J, Micks E. Depression during perimenopause: the role of the obstetrician-gynecologist. Arch Womens Ment Health 2020; 23:1-10. [PMID: 30758732 DOI: 10.1007/s00737-019-0950-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 01/31/2019] [Indexed: 02/07/2023]
Abstract
Depression in women is more common during perimenopause (the transition to menopause) than at other times in the life cycle. Symptoms of depression may be different in perimenopausal women compared to younger or older women, and are often dismissed as part of normal menopause. This is an expert narrative review. There are several evidence-based screening modalities which can be integrated into routine women's health visits, and can facilitate distinguishing between depression and normal perimenopausal symptoms. There is emerging evidence regarding the effect of hormonal changes on the development of perimenopausal depression and its optimal treatment, though critical research gaps remain. Obstetrician-gynecologists and other primary care providers play a vital role in the detection and management of depression in women. Providers caring for women during perimenopause have a unique opportunity to diagnose depression in their patients and identify appropriate treatment options.
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Affiliation(s)
- Greta B Raglan
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Jay Schulkin
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, 1959 NE Pacific St., Box 356460, Seattle, WA, 98195-6460, USA
| | - Elizabeth Micks
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, 1959 NE Pacific St., Box 356460, Seattle, WA, 98195-6460, USA.
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7
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Reilly TJ, Sagnay de la Bastida VC, Joyce DW, Cullen AE, McGuire P. Exacerbation of Psychosis During the Perimenstrual Phase of the Menstrual Cycle: Systematic Review and Meta-analysis. Schizophr Bull 2020; 46:78-90. [PMID: 31071226 PMCID: PMC6942155 DOI: 10.1093/schbul/sbz030] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Psychotic disorders can be exacerbated by the hormonal changes associated with childbirth, but the extent to which exacerbations occur with the menstrual cycle is unclear. We addressed this issue by conducting a systematic review. Embase, Medline, and PsychINFO databases were searched for studies that measured exacerbations of psychotic disorders in relation to the menstrual cycle. We extracted exacerbation measure, definition of menstrual cycle phase, and measurement of menstrual cycle phase. Standard incidence ratios were calculated for the perimenstrual phase based on the observed admissions during this phase divided by the expected number of admissions if the menstrual cycle had no effect. Random effects models were used to examine pooled rates of psychiatric admission in the perimenstrual phase. Nineteen studies, comprising 1193 participants were eligible for inclusion. Eleven studies examined psychiatric admission rates, 5 examined symptoms scores, 2 examined self-reported exacerbation, and 1 examined both admission rates and symptom scores. A random effects model demonstrated the rate of admissions during the perimenstrual phase was 1.48 times higher than expected (95% CI: 1.31-1.67), with no significant heterogeneity detected. Four of six symptom score studies reported perimenstrual worsening, but lack of consistency in timepoints precluded meta-analysis. Two studies examining self-reported menstrual exacerbations reported prevalences ranging from 20% to 32.4%. Psychiatric admission rates are significantly higher than expected during the perimenstrual phase. There is some evidence that a worsening of psychotic symptoms also occurs during this phase, but further research with more precise measurement of the menstrual cycle and symptomatology is required.
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Affiliation(s)
- Thomas J Reilly
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, SE5 8AF, UK,To whom correspondence should be addressed; Department of Psychosis, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, SE5 8AF, UK; tel: +44-20-7848-5233, fax: +44-20-7848-0976, e-mail:
| | - Vanessa C Sagnay de la Bastida
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, SE5 8AF, UK
| | - Dan W Joyce
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, SE5 8AF, UK
| | - Alexis E Cullen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, SE5 8AF, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, SE5 8AF, UK
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8
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Abstract
PURPOSE OF REVIEW We review recent data on bipolar disorder in menopausal-aged women, particularly in women undergoing the menopausal transition (MT). We discuss evidence on the severity of symptoms in bipolar women during the MT. Moreover, we address two factors in bipolar disorder and menopausal research: standardized menopausal staging and women's conceptualization of their menopausal and bipolar symptoms. RECENT FINDINGS While there are few studies within the last 5 years on bipolar women undergoing the MT, new evidence suggest that mood symptoms in women worsen with progression through the MT. Consistent use of the standardized menopausal staging system can facilitate understanding of the timing of worsening symptoms. Moreover, whether women conceptualize their symptoms as arising from their MT or bipolar disorder can influence whether they seek hormonal therapy or psychiatric treatment, respectively. The MT is a potential time for mood instability in vulnerable women, which can manifest as first-onset development of bipolar disorder or increased symptom severity in women with pre-existing bipolar disorder. Adoption of a standardized menopausal staging may offer novel frameworks for understanding of the role of the MT in bipolar disorder.
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Affiliation(s)
- Dawn Truong
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Wendy Marsh
- Department of Psychiatry, University of Massachusetts Memorial Medical Center, University of Massachusetts Medical School, 55 Lake Avenue, North, Worcester, MA, 01655, USA.
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9
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Gogos A, Ney LJ, Seymour N, Van Rheenen TE, Felmingham KL. Sex differences in schizophrenia, bipolar disorder, and post-traumatic stress disorder: Are gonadal hormones the link? Br J Pharmacol 2019; 176:4119-4135. [PMID: 30658014 PMCID: PMC6877792 DOI: 10.1111/bph.14584] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 11/13/2018] [Accepted: 11/25/2018] [Indexed: 12/30/2022] Open
Abstract
In this review, we describe the sex differences in prevalence, onset, symptom profiles, and disease outcome that are evident in schizophrenia, bipolar disorder, and post-traumatic stress disorder. Women with schizophrenia tend to exhibit less disease impairment than men. By contrast, women with post-traumatic stress disorder are more affected than men. The most likely candidates to explain these sex differences are gonadal hormones. This review details the clinical evidence that oestradiol and progesterone are dysregulated in these psychiatric disorders. Notably, existing data on oestradiol, and to a lesser extent, progesterone, suggest that low levels of these hormones may increase the risk of disease development and worsen symptom severity. We argue that future studies require a more inclusive, considered analysis of gonadal steroid hormones and the intricacies of the interactions between them, with methodological rigour applied, to enhance our understanding of the roles of steroid hormones in psychiatric disorders. LINKED ARTICLES: This article is part of a themed section on The Importance of Sex Differences in Pharmacology Research. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.21/issuetoc.
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Affiliation(s)
- Andrea Gogos
- Hormones in Psychiatry LaboratoryFlorey Institute of Neuroscience and Mental HealthParkvilleVictoriaAustralia
| | - Luke J. Ney
- School of Medicine (Psychology)University of TasmaniaSandy BayTasmaniaAustralia
| | - Natasha Seymour
- Hormones in Psychiatry LaboratoryFlorey Institute of Neuroscience and Mental HealthParkvilleVictoriaAustralia
- Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneParkvilleVictoriaAustralia
| | - Tamsyn E. Van Rheenen
- Melbourne Neuropsychiatry Centre, Department of PsychiatryUniversity of MelbourneParkvilleVictoriaAustralia
- Centre for Mental Health, School of Health Sciences, Faculty of Health, Arts and DesignSwinburne UniversityMelbourneVictoriaAustralia
| | - Kim L. Felmingham
- School of Psychological SciencesUniversity of MelbourneParkvilleVictoriaAustralia
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10
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Rej S, Quayle W, Forester BP, Dols A, Gatchel J, Chen P, Gough S, Fox R, Sajatovic M, Strejilevich SA, Eyler LT. Measurement tools for assessment of older age bipolar disorder: A systematic review of the recent global literature. Bipolar Disord 2018; 20:359-369. [PMID: 29108106 DOI: 10.1111/bdi.12566] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 08/04/2017] [Accepted: 09/15/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES More than 50% of people with bipolar disorder will be age 60 years or older by 2030. There is a need for more data to guide assessment and treatment in older age bipolar disorder (OABD); however, interpretation of findings from small, single-site studies may not be generalizable and there are few large trials. As a step in the direction of coordinated large-scale OABD data collection, it is critical to identify which measurements are currently used and identify potential gaps in domains typically assessed. METHODS An international group of OABD experts performed a systematic literature review to identify studies examining OABD in the past 6 years. Relevant articles were assessed to categorize the types of clinical, cognitive, biomarker, and neuroimaging OABD tools routinely used in OABD studies. RESULTS A total of 53 papers were identified, with a broad range of assessments. Most studies evaluated demographic and clinical domains, with fewer studies assessing cognition. There are relatively few biomarker and neuroimaging data, and data collection methods were less comprehensively covered. CONCLUSION Assessment tools used in the recent OABD literature may help to identify both a minimum and a comprehensive dataset that should be evaluated in OABD. Our review also highlights gaps where key clinical outcomes have not been routinely assessed. Biomarker and neuroimaging assessment could be further developed and standardized. Clinical data could be combined with neuroimaging, genetic, and other biomarkers in large-scale coordinated data collection to further improve our understanding of OABD phenomenology and biology, thereby contributing to research that advances care.
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Affiliation(s)
- Soham Rej
- GeriPARTy Group, Division of Geriatric Psychiatry, Jewish General Hospital, McGill University, Montreal, Canada
| | - William Quayle
- Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Brent P Forester
- Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Annemiek Dols
- Department of Old Age Psychiatry, GGZ inGeest, EMGO Institute of Care and Health Research, VU University Medical Centre, Amsterdam, the Netherlands
| | - Jennifer Gatchel
- Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Peijun Chen
- Departments of Psychiatry& Neurology, Case Western Reserve University School of Medicine, University Hospitals Case Medical Centre, Cleveland, OH, USA.,Psychiatry Service, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Sarah Gough
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Rebecca Fox
- GeriPARTy Group, Division of Geriatric Psychiatry, Jewish General Hospital, McGill University, Montreal, Canada
| | - Martha Sajatovic
- Departments of Psychiatry& Neurology, Case Western Reserve University School of Medicine, University Hospitals Case Medical Centre, Cleveland, OH, USA
| | - Sergio A Strejilevich
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina
| | - Lisa T Eyler
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.,Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA
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11
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Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Bond DJ, Frey BN, Sharma V, Goldstein BI, Rej S, Beaulieu S, Alda M, MacQueen G, Milev RV, Ravindran A, O'Donovan C, McIntosh D, Lam RW, Vazquez G, Kapczinski F, McIntyre RS, Kozicky J, Kanba S, Lafer B, Suppes T, Calabrese JR, Vieta E, Malhi G, Post RM, Berk M. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord 2018; 20:97-170. [PMID: 29536616 PMCID: PMC5947163 DOI: 10.1111/bdi.12609] [Citation(s) in RCA: 930] [Impact Index Per Article: 155.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/21/2017] [Indexed: 12/14/2022]
Abstract
The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third- line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment-emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second- line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence-based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first-line treatments for acute mania. First-line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first-line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.
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Affiliation(s)
- Lakshmi N Yatham
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | | | - Sagar V Parikh
- Department of PsychiatryUniversity of MichiganAnn ArborMIUSA
| | - Ayal Schaffer
- Department of PsychiatryUniversity of TorontoTorontoONCanada
| | - David J Bond
- Department of PsychiatryUniversity of MinnesotaMinneapolisMNUSA
| | - Benicio N Frey
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada
| | - Verinder Sharma
- Departments of Psychiatry and Obstetrics & GynaecologyWestern UniversityLondonONCanada
| | | | - Soham Rej
- Department of PsychiatryMcGill UniversityMontrealQCCanada
| | - Serge Beaulieu
- Department of PsychiatryMcGill UniversityMontrealQCCanada
| | - Martin Alda
- Department of PsychiatryDalhousie UniversityHalifaxNSCanada
| | - Glenda MacQueen
- Department of PsychiatryUniversity of CalgaryCalgaryABCanada
| | - Roumen V Milev
- Departments of Psychiatry and PsychologyQueen's UniversityKingstonONCanada
| | - Arun Ravindran
- Department of PsychiatryUniversity of TorontoTorontoONCanada
| | | | - Diane McIntosh
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Raymond W Lam
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Gustavo Vazquez
- Departments of Psychiatry and PsychologyQueen's UniversityKingstonONCanada
| | - Flavio Kapczinski
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada
| | | | - Jan Kozicky
- School of Population and Public HealthUniversity of British ColumbiaVancouverBCCanada
| | | | - Beny Lafer
- Department of PsychiatryUniversity of Sao PauloSao PauloBrazil
| | - Trisha Suppes
- Bipolar and Depression Research ProgramVA Palo AltoDepartment of Psychiatry & Behavioral Sciences Stanford UniversityStanfordCAUSA
| | - Joseph R Calabrese
- Department of PsychiatryUniversity Hospitals Case Medical CenterCase Western Reserve UniversityClevelandOHUSA
| | - Eduard Vieta
- Bipolar UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPS, CIBERSAMBarcelonaCataloniaSpain
| | - Gin Malhi
- Department of PsychiatryUniversity of SydneySydneyNSWAustralia
| | - Robert M Post
- Department of PsychiatryGeorge Washington UniversityWashingtonDCUSA
| | - Michael Berk
- Deakin UniveristyIMPACT Strategic Research CentreSchool of Medicine, Barwon HealthGeelongVic.Australia
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12
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Perich T, Ussher J, Parton C. "Is it menopause or bipolar?": a qualitative study of the experience of menopause for women with bipolar disorder. BMC WOMENS HEALTH 2017; 17:110. [PMID: 29145856 PMCID: PMC5689207 DOI: 10.1186/s12905-017-0467-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 11/07/2017] [Indexed: 12/25/2022]
Abstract
Background Menopause can be a time of change for women and may be marked by disturbances in mood. For women living with a mental illness, such as bipolar disorder, little is known about how they experience mood changes during menopause. This study aimed to explore how women with bipolar disorder constructed mood changes during menopause and how this impacted on treatment decisions. Methods Semi-structured interviews were undertaken with fifteen women who reported they had been diagnosed with bipolar disorder. Data was analysed using thematic analysis guided by a social constructionist framework. Results Themes identified included ‘Constructions of mood change: menopause or bipolar disorder?’,‘ Life events, bipolar disorder and menopause coming together’; ‘Treatment choices for mood change during menopause’. Conclusions The accounts suggested that women related to the experience of mood changes during menopause through the lens of their existing framework of bipolar disorder, with implications for understanding of self and treatment choices. Electronic supplementary material The online version of this article (10.1186/s12905-017-0467-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tania Perich
- Clinical and Health Psychology Research Initiative (CaHPRI), School of Social Sciences and Psychology, Western Sydney University, Sydney, Australia. .,School of Psychiatry, University of New South Wales, Sydney, Australia.
| | - Jane Ussher
- Translational Health Research Institute, Western Sydney University, Sydney, Australia
| | - Chloe Parton
- Translational Health Research Institute, Western Sydney University, Sydney, Australia
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Hu LY, Shen CC, Hung JH, Chen PM, Wen CH, Chiang YY, Lu T. Risk of Psychiatric Disorders Following Symptomatic Menopausal Transition: A Nationwide Population-Based Retrospective Cohort Study. Medicine (Baltimore) 2016; 95:e2800. [PMID: 26871843 PMCID: PMC4753939 DOI: 10.1097/md.0000000000002800] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Menopausal transition is highly symptomatic in at least 20% of women. A higher prevalence of psychiatric symptoms, including depression, anxiety, and sleep disturbance, has been shown in women with symptomatic menopausal transition. However, a clear correlation between symptomatic menopausal transition and psychiatric disorders has not been established.We explored the association between symptomatic menopausal transition and subsequent newly diagnosed psychiatric disorders, including schizophrenia as well as bipolar, depressive, anxiety, and sleep disorders.We investigated women who were diagnosed with symptomatic menopausal transition by an obstetrician-gynecologist according to the data in the Taiwan National Health Insurance Research Database. A comparison cohort comprised age-matched women without symptomatic menopausal transition. The incidence rate and the hazard ratios of subsequent newly diagnosed psychiatric disorders were evaluated in both cohorts, based on the diagnoses of psychiatrists.The symptomatic menopausal transition and control cohorts each consisted of 19,028 women. The incidences of bipolar disorders (hazard ratio [HR] = 1.69, 95% confidence interval [CI] = 1.01-2.80), depressive disorders (HR = 2.17, 95% CI = 1.93-2.45), anxiety disorders (HR = 2.11, 95% CI = 1.84-2.41), and sleep disorders (HR = 2.01, 95% CI = 1.73-2.34) were higher among the symptomatic menopausal transition women than in the comparison cohort. After stratifying for follow-up duration, the incidence of newly diagnosed bipolar disorders, depressive disorders, anxiety disorders, and sleep disorders following a diagnosis of symptomatic menopausal transition remained significantly increased in the longer follow-up groups (1-5 and ≥ 5 years).Symptomatic menopausal transition might increase the risk of subsequent newly onset bipolar disorders, depressive disorders, anxiety disorders, and sleep disorders. A prospective study is necessary to confirm these findings.
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Affiliation(s)
- Li-Yu Hu
- From the Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung (LYH, TL); School of Medicine, National Yang-Ming University, Taipei (LYH); Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital (C-CS); Department of Information Management, National Chung-Cheng University, Chiayi (C-CS); Department of Obstetrics and Gynecology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation (J-HH); School of Medicine, Tzu Chi University, Hualien (J-HH); Department of Psychiatry, Yuanshan and Suao Branch, Taipei Veterans General Hospital (P-MC); Department of Anesthesiology, Kaohsiung Veterans General Hospital, Kaohsiung (C-HW); and Department of Dental Technology and Materials Science, Central Taiwan University of Science and Technology, Taiwan (Y-YC)
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Marsh WK, Gershenson B, Rothschild AJ. Symptom severity of bipolar disorder during the menopausal transition. Int J Bipolar Disord 2015; 3:35. [PMID: 26296381 PMCID: PMC4546121 DOI: 10.1186/s40345-015-0035-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 07/28/2015] [Indexed: 11/12/2022] Open
Abstract
Background Little is known about the mood symptom experience of women with bipolar disorder during the menopausal transition (MT). Yet times of rapid hormonal decline, such as the postpartum, are associated with increased risk of severe mood episodes in bipolar disorder, and the MT is a time of increased risk for unipolar depression in women with or without a history of depression. Methods Enrollment included 56 women 40–60 years old diagnosed in the bipolar spectrum who were experiencing menopausal symptoms or were up to 5 years since their final menstrual period. Menopausal stages included early menopause, late menopause, or early postmenopause based on standardized criteria. Observational, prospective standardized mood symptom and reproductive hormone assessments were completed periodically. Concurrent menopausal symptoms as well as history of mood exacerbation during past reproductive events were assessed. Results Forty-four women were included in the main analysis. The average Montgomery-Asberg Depression Rating Scale (MADRS) score was 4.43 points higher in the late transition/early postmenopausal stage women (n = 29) compared to the early menopausal stage women (n = 15) (±SE 2.14; p = 0.039), corresponding to a roughly 10 % higher score (range 0–40) in the late/post stage across all study visits. Results were similar for the Young Mania Rating Scale (YMRS), where the average score was 2.54 points higher in the late/early postmenopausal stage women compared to the early menopausal stage women (±SE 1.15; p = 0.027), also roughly 10 % higher (range 0–26). Estradiol and follicle-stimulating hormone (FSH) absolute levels as well as between-visit change in levels were not notably associated with YMRS or MADRS during study observation. Total Greene Climacteric Symptom (menopausal symptom) score was significantly associated with MADRS but not YMRS. History of mood exacerbation premenstrually and/or postpartum was not significantly associated with YMRS or MADRS severity during the MT. Conclusions These results support the theory that times of increased reproductive hormonal changes, such as the late MT and early postmenopause, here compared to early MT, are associated with greater mood symptom severity in bipolar spectrum women. Nonetheless, absolute or change in FSH and estradiol levels were not significantly associated with depression or mood elevation severity.
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Affiliation(s)
- Wendy K Marsh
- Department of Psychiatry, School of Medicine, University of Massachusetts, 55 Lake Ave North, S3-314, Worcester, MA, 01655, USA,
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15
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Fortress AM, Frick KM. Epigenetic regulation of estrogen-dependent memory. Front Neuroendocrinol 2014; 35:530-49. [PMID: 24878494 PMCID: PMC4174980 DOI: 10.1016/j.yfrne.2014.05.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 05/15/2014] [Accepted: 05/16/2014] [Indexed: 02/09/2023]
Abstract
Hippocampal memory formation is highly regulated by post-translational histone modifications and DNA methylation. Accordingly, these epigenetic processes play a major role in the effects of modulatory factors, such as sex steroid hormones, on hippocampal memory. Our laboratory recently demonstrated that the ability of the potent estrogen 17β-estradiol (E2) to enhance hippocampal-dependent novel object recognition memory in ovariectomized female mice requires ERK-dependent histone H3 acetylation and DNA methylation in the dorsal hippocampus. Although these data provide valuable insight into the chromatin modifications that mediate the memory-enhancing effects of E2, epigenetic regulation of gene expression is enormously complex. Therefore, more research is needed to fully understand how E2 and other hormones employ epigenetic alterations to shape behavior. This review discusses the epigenetic alterations shown thus far to regulate hippocampal memory, briefly reviews the effects of E2 on hippocampal function, and describes in detail our work on epigenetic regulation of estrogenic memory enhancement.
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Affiliation(s)
- Ashley M Fortress
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, United States
| | - Karyn M Frick
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, United States.
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Kulkarni J, Berk M, Wang W, Mu L, Scarr E, Van Rheenen TE, Worsley R, Gurvich C, Gavrilidis E, de Castella A, Fitzgerald P, Davis SR. A four week randomised control trial of adjunctive medroxyprogesterone and tamoxifen in women with mania. Psychoneuroendocrinology 2014; 43:52-61. [PMID: 24703170 DOI: 10.1016/j.psyneuen.2014.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/05/2014] [Accepted: 02/06/2014] [Indexed: 10/25/2022]
Abstract
Emerging research has suggested that hormone treatments such as selective oestrogen receptor modulators (SERMs) or progestins may be useful in the treatment of mania. The current pilot study compared the use of the SERM tamoxifen and the progestin medroxyprogesterone acetate (MPA), as an adjunct to mood stabiliser medications, for the treatment of mania symptoms in 51 women in a 28-day double blind, placebo controlled study. The primary outcome was the change between baseline and day 28 mania scores as measured by the Clinician Administered Rating Scale for Mania (CARS-M). Adjunctive MPA treatment provided greater and more rapid improvement in mania symptoms compared with adjunctive placebo and tamoxifen treatment. Adjunctive therapy with MPA may be a potentially useful new treatment for persistent mania, leading to a greater and more rapid resolution of symptoms compared with mood stabiliser treatment alone.
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Affiliation(s)
- Jayashri Kulkarni
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and the Alfred Hospital, Melbourne, Victoria 3004, Australia.
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Ryrie Street, Geelong, Victoria 3220, Australia
| | - Wei Wang
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and the Alfred Hospital, Melbourne, Victoria 3004, Australia
| | - Ling Mu
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and the Alfred Hospital, Melbourne, Victoria 3004, Australia
| | - Elizabeth Scarr
- The Florey Institute of Neuroscience and Mental Health Victoria, Parkville, Victoria 3052, Australia
| | - Tamsyn E Van Rheenen
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and the Alfred Hospital, Melbourne, Victoria 3004, Australia
| | - Roisin Worsley
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and the Alfred Hospital, Melbourne, Victoria 3004, Australia; Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University and Alfred Hospital, Victoria 3004, Australia
| | - Caroline Gurvich
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and the Alfred Hospital, Melbourne, Victoria 3004, Australia
| | - Emorfia Gavrilidis
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and the Alfred Hospital, Melbourne, Victoria 3004, Australia
| | - Anthony de Castella
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and the Alfred Hospital, Melbourne, Victoria 3004, Australia
| | - Paul Fitzgerald
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and the Alfred Hospital, Melbourne, Victoria 3004, Australia
| | - Susan R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University and Alfred Hospital, Victoria 3004, Australia
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Abstract
BACKGROUND It appears that the female reproductive events and hormonal treatments may impact the course of bipolar disorder in women. In particular, childbirth is known to be associated with onset of affective episodes in women with bipolar disorder. During the female reproductive events the sex hormones, e.g. estrogen, are fluctuating and particularly postpartum there is a steep fall in the levels of serum estrogen. The role of estrogen in women with bipolar disorder is, however, not fully understood. AIM The main objective of this review is to evaluate the possible relation between serum estrogen levels and women with bipolar disorder including studies of the anti manic effects of the selective estrogen receptor modulator tamoxifen. METHOD A systematically literature search on PubMed was conducted: two studies regarding the connection between serum estrogen levels and women with bipolar disorder were identified. Furthermore, four studies were found concerning the antimanic effects of tamoxifen. RESULTS Both studies in the estrogen studies showed very low levels of estrogen in women with postpartum psychosis and significant improvement of symptoms after treatment with estrogen. The four tamoxifen studies found that tamoxifen was effective in producing antimanic effects. CONCLUSION These results indicate that estrogen fluctuations may be an important factor in the etiology of bipolar disorder and it is obvious that more research on this topic is needed to clarify the role of estrogen in women with bipolar disorder.
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Affiliation(s)
- Ninja Meinhard
- Psychiatric Center Copenhagen, Rigshospitalet, University Hospital of Copenhagen , Blegdamsvej 9, DK-2100 Copenhagen , Denmark
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Bauer M, Glenn T, Pilhatsch M, Pfennig A, Whybrow PC. Gender differences in thyroid system function: relevance to bipolar disorder and its treatment. Bipolar Disord 2014; 16:58-71. [PMID: 24245529 DOI: 10.1111/bdi.12150] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [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: 12/21/2022]
Abstract
OBJECTIVES Thyroid hormones play a critical role in the functioning of the adult brain, and thyroid diseases impair both mood and cognition. This paper reviews gender differences in thyroid system function that are relevant to the diagnosis and treatment of bipolar disorder. METHODS The study comprised a comprehensive literature review of gender differences in thyroid disease that are pertinent to mood disorders. RESULTS The prevalence of thyroid disease was found to be much higher in females than males, and to increase with age. The most commonly detected abnormality was subclinical hypothyroidism, which was found to occur in up to 20% of postmenopausal women. Females also had higher rates of thyroid autoimmunity. Individuals at risk for thyroid disease, such as adult females, may have had less ability to compensate for additional challenges to thyroid metabolism, including lithium treatment. Thyroid abnormalities were associated with a poorer response to standard treatments for mood disorders. Females with treatment-resistant mood disorders may have responded better than males to adjunctive therapy with thyroid hormones. CONCLUSIONS Disturbances of thyroid system function, which occur commonly in females, may complicate the diagnosis and treatment of mood disorders. In particular, this is clinically relevant during lithium treatment because lithium may impair vital thyroid metabolic pathways secondary to its anti-thyroid activity.
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Affiliation(s)
- Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Saul MC, Stevenson SA, Gammie SC. Sexually dimorphic, developmental, and chronobiological behavioral profiles of a mouse mania model. PLoS One 2013; 8:e72125. [PMID: 23967278 PMCID: PMC3742520 DOI: 10.1371/journal.pone.0072125] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 07/09/2013] [Indexed: 01/12/2023] Open
Abstract
Bipolar disorders are heritable psychiatric conditions often abstracted by separate animal models for mania and depression. The principal mania models involve transgenic manipulations or treatment with stimulants. An additional approach involves analysis of naturally occurring mania models including an inbred strain our lab has recently characterized, the Madison (MSN) mouse strain. These mice show a suite of behavioral and neural genetic alterations analogous to manic aspects of bipolar disorders. In the current study, we extended the MSN strain's behavioral phenotype in new directions by examining in-cage locomotor activity. We found that MSN activity presentation is sexually dimorphic, with MSN females showing higher in-cage activity than MSN males. When investigating development, we found that MSN mice display stable locomotor hyperactivity already observable when first assayed at 28 days postnatal. Using continuous monitoring and analysis for 1 month, we did not find evidence of spontaneous bipolarism in MSN mice. However, we did find that the MSN strain displayed an altered diurnal activity profile, getting up earlier and going to sleep earlier than control mice. Long photoperiods were associated with increased in-cage activity in MSN, but not in the control strain. The results of these experiments reinforce the face validity of the MSN strain as a complex mania model, adding sexual dimorphism, an altered diurnal activity profile, and seasonality to the suite of interesting dispositional phenomena related to mania seen in MSN mice.
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Affiliation(s)
- Michael C Saul
- Department of Zoology, University of Wisconsin-Madison, Madison, Wisconsin, USA.
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