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Dehnavi SI, Mortazavi SS, Ramezani MA, Gharraee B, Ashouri A. Emotion-focused therapy for women with premenstrual dysphoric disorder: a randomized clinical controlled trial. BMC Psychiatry 2024; 24:501. [PMID: 38992619 PMCID: PMC11238458 DOI: 10.1186/s12888-024-05681-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 03/13/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Premenstrual dysphoric disorder (PMDD) is a debilitating condition, affecting women of reproductive age. It is characterized by severe periodic physical and psychological symptoms, which end after the onset of menstruation. This study aimed to evaluate the effectiveness of emotion-focused therapy (EFT) for PMDD patients. METHODS A total of 48 PMDD women, in the age range of 18-44 years, were randomly assigned to two intervention and control groups. The intervention group participated in 16 weeks of EFT treatment, while the control group was selected based on the waiting list (waitlist control group) and followed-up after three months. Forty-four patients finally completed this study. The participants completed the Premenstrual Syndrome Screening Tool (PSST), Difficulties in Emotion Regulation Scale (DERS), and Depression Anxiety Stress Scale-21 (DASS-21) in the first premenstrual period before treatment, the first premenstrual period after treatment, and the premenstrual period three months after treatment. RESULTS Based on the repeated measure analysis of variances, the total score of DERS and the total score of PSST decreased significantly (P < 0.05). Also, in DASS-21, the scores of depression and stress subscales reduced significantly (P < 0.05), while there was no significant decrease in the score of anxiety subscale (P > 0.05). CONCLUSION Based on the present results, EFT can be an effective treatment for alleviating the symptoms of PMDD. This treatment can reduce the emotion regulation difficulties of women with PMDD and alleviate the symptoms of depression and stress. TRIAL REGISTRATION Iranian Registry of Clinical Trials, IRCT ID: IRCT20220920055998N1, Registered on: 12/2/2023.
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Affiliation(s)
- Saeideh Izadi Dehnavi
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health, Tehran Institute of Psychiatry, Iran University of Medical Sciences, Tehran, 1445613111, Iran
| | - Seyede Salehe Mortazavi
- Geriatric Mental Health Research Center, School of Behavioral Sciences and Mental Health, Tehran Institute of Psychiatry, Iran University of Medical Sciences, Tehran, 1445613111, Iran
| | | | - Banafshe Gharraee
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health, Tehran Institute of Psychiatry, Iran University of Medical Sciences, Tehran, 1445613111, Iran
| | - Ahmad Ashouri
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health, Tehran Institute of Psychiatry, Iran University of Medical Sciences, Tehran, 1445613111, Iran.
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Effect of Garlic ( Allium sativum) Supplementation on Premenstrual Disorders: A Randomized, Double-Blind, Placebo-Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:9965064. [PMID: 34760020 PMCID: PMC8575623 DOI: 10.1155/2021/9965064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 10/07/2021] [Indexed: 11/22/2022]
Abstract
Background Premenstrual disorders involve physical, behavioral, and mood variations that affect women of childbearing age and interfere with family relationships, household responsibilities, professional duties, and social activities. Objectives Considering the side effects of conventional medications, their use is not recommended except in severe cases of premenstrual disorders. Nowadays, there is a tendency to use traditional and complementary medicine that offers various treatments. The purpose of the current study was to investigate the impacts of garlic as a herbal medicine on the severity of premenstrual symptoms. Methods This study was a double-blind, randomized, controlled trial. After identification of participants with moderate-to-severe PMS through the premenstrual symptoms screening tools questionnaire (PSST), they were randomly assigned to placebo (n = 64) or garlic (n = 65) groups. Each participant received one tablet daily for three consecutive cycles and logged the severity of their symptoms in the PSST questionnaire during the intervention period. Results There was no significant difference between the two groups in the baseline level of premenstrual symptoms before the intervention. After treatment with garlic for three consecutive cycles, the total score of the severity of premenstrual symptoms significantly (P < 0.001) reduced from 34.09 ± 7.31 to 11.21 ± 7.17. In the placebo group, this score changed from 33.35 ± 7.96 to 24.28 ± 7.22. The difference between mean changes in the two groups was 13.78, with a 95% Confidence Interval (CI) of 11.23–16.33. No serious side effects were observed in either group. Conclusion Our findings highlight the potential effect of garlic in reducing the severity of premenstrual symptoms; therefore, the use of garlic can be considered as an alternative therapy in the prevention and treatment of premenstrual disorders.
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Sepede G, Brunetti M, Di Giannantonio M. Comorbid Premenstrual Dysphoric Disorder in Women with Bipolar Disorder: Management Challenges. Neuropsychiatr Dis Treat 2020; 16:415-426. [PMID: 32103961 PMCID: PMC7020916 DOI: 10.2147/ndt.s202881] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 01/30/2020] [Indexed: 12/16/2022] Open
Abstract
Bipolar disorder (BD) and premenstrual dysphoric disorder (PMDD) are two cyclic mood illnesses, sometimes presenting together. Their comorbidity appears to be linked to common biological mechanisms and usually results in more severity of mood symptoms and a poorer long-term outcome. Nevertheless, the management of comorbid PMDD/BD has been scarcely studied. Therefore, the aim of the present paper was to review the published literature on the treatment of comorbid PMDD/BD and to provide point-by-point hypotheses to address these complex clinical cases. We searched PubMed to identify the studies focused on the treatment and management of comorbid PMDD/BD using the following search words, alone and in combination: premenstrual dysphoric disorder, bipolar disorder, comorbid, treatment, management, pharmacotherapy, psychotherapy. The search was conducted on the 1st of June 2019 and yielded 55 records. Four papers met our inclusion/exclusion criteria and were therefore included in our qualitative synthesis. Integrating the few data pertaining to the treatment of comorbid PMDD/BD with the large amount of published data on the two conditions separately, we can suggest that the management of comorbid PMDD/BD needs as a first step to stabilize the bipolar symptoms by means of optimal dosages of mood stabilizers. Then, in euthymic BD patients, the PMDD symptoms could be treated with estroprogestins (first-line treatment). On the contrary, during acute phases of BD, antidepressants (for major depressive episodes) and atypical antipsychotics/hormonal modulators (for manic episodes) could be considered as promising add-on treatments to mood stabilizers. In case of resistant PMDD/BD symptoms, combined strategies should be taken into account, as well as alternative treatments, such as lifestyle changes. In conclusion, RCTs on comorbid PMDD/BD are still lacking. The management of this complex condition is therefore challenging and it requires a tailored treatment.
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Affiliation(s)
- Gianna Sepede
- Department of Neuroscience, Imaging, and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy
| | - Marcella Brunetti
- Department of Neuroscience, Imaging, and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy
| | - Massimo Di Giannantonio
- Department of Neuroscience, Imaging, and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy.,Department of Mental Health - Chieti, National Health Trust, Chieti, Italy
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Abstract
Premenstrual dysphoric disorder (PMDD) comprises emotional and physical symptoms and functional impairment that lie on the severe end of the continuum of premenstrual symptoms. Women with PMDD have a differential response to normal hormonal fluctuations. This susceptibility may involve the serotonin system, altered sensitivity of the GABAA receptor to the neurosteroid allopregnanalone, and altered brain circuitry involving emotional and cognitive functions. Serotonin reuptake inhibitors are considered the first-line treatment. Second-line treatments include oral contraceptives containing drospirenone, other ovulation suppression methods, calcium, chasteberry, and cognitive-behavioral therapy.
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Affiliation(s)
- Teresa Lanza di Scalea
- Assistant Professor of Psychiatry and Women's Health, Dell Medical School, University of Texas at Austin, Austin, TX, USA.
| | - Teri Pearlstein
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Women's Behavioral Medicine, Women's Medicine Collaborative, Miriam Hospital, 146 West River Street, Providence, RI 02904, USA
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Reid RL, Soares CN. Premenstrual Dysphoric Disorder: Contemporary Diagnosis and Management. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 40:215-223. [PMID: 29132964 DOI: 10.1016/j.jogc.2017.05.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 05/04/2017] [Indexed: 11/17/2022]
Abstract
Most ovulatory women experience premenstrual symptoms (premenstrual syndrome, molimina) which indicate impending menstruation and are of little clinical relevance because they do not affect quality of life. A few women, however, experience significant physical and/or psychological symptoms before menstruation that, if left untreated, would result in deterioration in functioning and relationships. The precise etiology remains elusive, although new theories are gaining support in pre-clinical and early clinical trials. Refined diagnostic criteria allow better discrimination of this condition from other psychiatric diagnoses and the selection of symptom appropriate therapies that afford relief for most women. Pharmacotherapies (particularly selective serotonin reuptake inhibitors and SNRIs) represent the first-line treatment for premenstrual dysphoric disorder and severe, mood-related premenstrual syndrome. Continuous combined oral contraceptives have limited evidence for usefulness in premenstrual dysphoric disorder, whereas medical ovarian suppression is often recommended for patients who fail to respond or cannot tolerate first-line treatments (e.g., selective serotonin reuptake inhibitors). The use of cognitive behavioural therapies is promising, but it remains limited by sparse data and restricted access to trained professionals. A proper diagnosis (particularly the distinction from other underlying psychiatric conditions) is crucial for the implementation of effective therapy and alleviation of this impairing condition.
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Affiliation(s)
- Robert L Reid
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Queen's University School of Medicine, Kingston, ON.
| | - Claudio N Soares
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON
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Abstract
Premenstrual dysphoric disorder (PMDD) comprises emotional and physical symptoms and functional impairment that lie on the severe end of the continuum of premenstrual symptoms. Women with PMDD have a differential response to normal hormonal fluctuations. This susceptibility may involve the serotonin system, altered sensitivity of the GABAA receptor to the neurosteroid allopregnanalone, and altered brain circuitry involving emotional and cognitive functions. Serotonin reuptake inhibitors are considered the first-line treatment. Second-line treatments include oral contraceptives containing drospirenone, other ovulation suppression methods, calcium, chasteberry, and cognitive-behavioral therapy.
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Affiliation(s)
- Teresa Lanza di Scalea
- Department of Psychiatry, Rhode Island Hospital and Miriam Hospital, 593 Eddy Street, Providence, RI 02903, USA.
| | - Teri Pearlstein
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Women's Behavioral Medicine, Women's Medicine Collaborative, Miriam Hospital, 146 West River Street, Providence, RI 02904, USA
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Hantsoo L, Epperson CN. Anxiety Disorders Among Women: A Female Lifespan Approach. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2017; 15:162-172. [PMID: 28966563 DOI: 10.1176/appi.focus.20160042] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Anxiety symptoms may present differently between women and men, and at different points in the female lifespan. The female lifespan includes distinct epochs of hormonal function, including puberty, the premenstruum, in some women pregnancy or postpartum, and the menopausal transition. These stages give rise to important treatment considerations when treating anxiety in women. When making assessments, the clinician should consider reproductive events and hormonal status, as well as sex differences in anxiety presentation. This review is structured to: 1) Define major epochs of the female lifespan, 2) Provide a brief summary of the major anxiety disorders, with a focus on prevalence and presentation in the context of sex differences and at points in the female lifespan, 3) Describe potential biopsychosocial underpinnings of anxiety disorders among women, 4) Provide guidelines for assessment and differential diagnosis, and 5) Describe treatment options with attention to reproductive events such as pregnancy.
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Affiliation(s)
- Liisa Hantsoo
- Clinical Psychologist & Instructor, Penn Center for Women's Behavioral Wellness, Perelman School of Medicine, University of Pennsylvania
| | - C Neill Epperson
- Professor of Psychiatry and Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania and Director of the Penn Center for Women's Behavioral Wellness and Penn PROMOTES Research on Sex and Gender in Health, Perelman School of Medicine, University of Pennsylvania
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Timby E, Bäckström T, Nyberg S, Stenlund H, Wihlbäck ACN, Bixo M. Women with premenstrual dysphoric disorder have altered sensitivity to allopregnanolone over the menstrual cycle compared to controls-a pilot study. Psychopharmacology (Berl) 2016; 233:2109-2117. [PMID: 26960697 DOI: 10.1007/s00213-016-4258-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/22/2016] [Indexed: 02/04/2023]
Abstract
RATIONALE In premenstrual dysphoric disorder (PMDD), a condition that afflicts 3-8 % of women in fertile ages, the cyclic recurrence of debilitating mood symptoms is restricted to the luteal phase of the menstrual cycle. The progesterone metabolite allopregnanolone is produced by the corpus luteum, and circulating levels are reflected in the brain. Allopregnanolone is a modulator of the GABAA receptor, enhancing the effect of γ-aminobutyric acid (GABA). Previous studies have demonstrated different sensitivity to other GABAA receptor agonists, i.e., benzodiazepines, alcohol, and pregnanolone, in PMDD patients compared to controls. OBJECTIVES This study aimed to investigate the sensitivity to intravenous allopregnanolone over the menstrual cycle in PMDD patients. METHODS Allopregnanolone, 0.05 mg/kg, was administered intravenously once in the mid-follicular and once in the luteal phase of the menstrual cycle to 10 PMDD patients and 10 control subjects. The saccadic eye velocity (SEV) was recorded by electrooculography as a measurement of functional GABAA receptor activity, at baseline and repeatedly after the injection. A mixed model was used to analyze data. RESULTS There was a highly significant group × phase interaction in the SEV response to allopregnanolone (F(1,327.489) = 12.747, p < 0.001). In the PMDD group, the SEV response was decreased in the follicular phase compared to the luteal phase (F(1,168) = 7.776, p = 0.006), whereas in the control group, the difference was opposite during the menstrual cycle (F(1,158.45) = 5.70, p = 0.018). CONCLUSIONS The effect of exogenous allopregnanolone is associated with menstrual cycle phase in PMDD patients and in controls. The results suggest an altered sensitivity to allopregnanolone in PMDD patients.
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Affiliation(s)
- Erika Timby
- Department of Clinical Science, Umeå University, 901 85, Umeå, Sweden
| | | | - Sigrid Nyberg
- Department of Clinical Science, Umeå University, 901 85, Umeå, Sweden
| | - Hans Stenlund
- Department of Public Health and Clinical Medicine, Umeå University, 901 85, Umeå, Sweden
| | | | - Marie Bixo
- Department of Clinical Science, Umeå University, 901 85, Umeå, Sweden. .,Department of Clinical Science, Obstetrics and Gynecology, Umeå University, 901 85, Umeå, Sweden.
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Tadakawa M, Takeda T, Monma Y, Koga S, Yaegashi N. The prevalence and risk factors of school absenteeism due to premenstrual disorders in Japanese high school students-a school-based cross-sectional study. Biopsychosoc Med 2016; 10:13. [PMID: 27118993 PMCID: PMC4845482 DOI: 10.1186/s13030-016-0067-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 04/21/2016] [Indexed: 11/18/2022] Open
Abstract
Background Premenstrual disorders such as premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) interfere with the daily lives of adolescents. The causes of PMS and PMDD are unknown, but lifestyle habits, such as regular exercise and taste preference are known to be associated. This study was conducted to investigate how premenstrual symptoms affect the school life in Japanese high school students and whether there was a risk factor for school absenteeism that is dependent on the types of premenstrual symptoms or lifestyle habits. Methods A school-based survey was conducted in Sendai, an industrial city in Japan. A total of 901 girls aged 15–19 with regular menstrual cycles were assessed using the self-reporting premenstrual symptoms questionnaire (PSQ) and questions regarding school absence, taste preference, and exercise. We classified the girls into ‘no/mild PMS’, ‘moderate-to-severe PMS’ and ‘PMDD’ according to the PSQ. The girls were classified into the ‘absent’ group if they were absent for more than 1 day per month. We used multivariate logistic analysis to examine the risk factors for school absenteeism. Results The rates of ‘moderate-to-severe PMS’ and ‘PMDD’ were 9.9 and 3.1 %, respectively. A total of 107 girls (11.9 %) were classified into the ‘absent’ group. Significant differences were observed in the prevalence of all premenstrual symptoms (p < 0.001), ‘age’ (p < 0.001), ‘a preference for salty food’ (p = 0.001), and ‘lack of regular exercise’ (p = 0.03) between the ‘absent’ and ‘non-absent’ groups. Multivariate analysis revealed that premenstrual symptoms such as ‘insomnia or hypersomnia’ (odds ratio [OR] 2.27, 95 % confidence interval [CI]: 1.46–4.17) and ‘physical symptoms’ (OR 2.24, 95 % CI: 1.37–3.66), ‘reduced social life activities’ (OR 2.71, 95 % CI 1.31–5.59), and ‘a preference for salty food’ (OR 1.89, 95 % CI: 1.20–2.98) were risk factors for school absenteeism. Conclusions One in nine Japanese female high school students were absent from school due to premenstrual symptoms. Physical premenstrual symptoms and lifestyles, such as a preference for salty food and a lack of regular exercise, were identified as risk factors for school absenteeism.
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Affiliation(s)
- Mari Tadakawa
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, 1-1 Seiryocho, Aobaku, Sendai, Japan
| | - Takashi Takeda
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, 1-1 Seiryocho, Aobaku, Sendai, Japan ; Division of Women's Health, Research Institute of Traditional Asian Medicine, Kindai University School of Medicine, 377-2 Ohno-Higasi, Osaka-Sayama, Osaka 589-8511 Japan
| | - Yasutake Monma
- Graduate Medical Education Center, Tohoku University Hospital, 1-1 Seiryocho, Aobaku, Sendai, Japan
| | - Shoko Koga
- Gynecology Clinic Koga, 2-5-12 Kashiwagi, Aobaku, Sendai, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, 1-1 Seiryocho, Aobaku, Sendai, Japan
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Pearlstein T. Treatment of Premenstrual Dysphoric Disorder: Therapeutic Challenges. Expert Rev Clin Pharmacol 2016; 9:493-496. [PMID: 26766596 DOI: 10.1586/17512433.2016.1142371] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Teri Pearlstein
- a Alpert Medical School of Brown University , Providence , RI , USA.,b Women's Behavioral Medicine , Women's Medicine Collaborative, a Lifespan partner , Providence , RI , USA
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Gillings MR. Were there evolutionary advantages to premenstrual syndrome? Evol Appl 2014; 7:897-904. [PMID: 25469168 PMCID: PMC4211719 DOI: 10.1111/eva.12190] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 07/01/2014] [Indexed: 01/24/2023] Open
Abstract
Premenstrual syndrome (PMS) affects up to 80% of women, often leading to significant personal, social and economic costs. When apparently maladaptive states are widespread, they sometimes confer a hidden advantage, or did so in our evolutionary past. We suggest that PMS had a selective advantage because it increased the chance that infertile pair bonds would dissolve, thus improving the reproductive outcomes of women in such partnerships. We confirm predictions arising from the hypothesis: PMS has high heritability; gene variants associated with PMS can be identified; animosity exhibited during PMS is preferentially directed at current partners; and behaviours exhibited during PMS may increase the chance of finding a new partner. Under this view, the prevalence of PMS might result from genes and behaviours that are adaptive in some societies, but are potentially less appropriate in modern cultures. Understanding this evolutionary mismatch might help depathologize PMS, and suggests solutions, including the choice to use cycle-stopping contraception.
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Affiliation(s)
- Michael R Gillings
- Department of Biological Sciences, Macquarie University Sydney, NSW, Australia
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Abstract
Premenstrual dysphoric disorder (PMDD) is comprised of a cluster of affective, behavioral and somatic symptoms recurring monthly during the luteal phase of the menstrual cycle. The disorder affects 3-8% of menstruating women and represents the more severe and disabling end of the spectrum of premenstrual disorders, which includes premenstrual syndrome and premenstrual aggravation of underlying affective disorder. Rigorous and specific diagnostic criteria for PMDD were specified in the Diagnostic and Statistical Manual of Mental Disorders IV (1994) and reaffirmed in the Diagnostic and Statistical Manual of Mental Disorders V (2013) and, consequently, there has been a marked increase in well-designed, placebo-controlled studies evaluating treatment modalities. Although the exact pathogenesis of PMDD is still elusive, treatment of PMDD and severe premenstrual syndrome has centered on neuromodulation via serotonin reuptake inhibitor antidepressants, and ovulation suppression utilizing various contraceptive and hormonal preparations. Unlike the approach to the treatment of depression, serotonergic antidepressants need not be given daily, but can be effective when used cyclically, only in the luteal phase or even limited to the duration of the monthly symptoms. Less, well-substantiated alternative treatments, such as calcium supplementation, agnus castus (chasteberry), Hypericum perforatum (St John's wort) and cognitive/behavioral/relaxation therapies, may be useful adjuncts in the treatment of PMDD. This review provides an overview of current information on the treatment of PMDD.
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Affiliation(s)
- Andrea J Rapkin
- Department of Obstetrics & Gynecology, David Geffen School of Medicine at UCLA, University of California Los Angeles, 10833 Le Conte Avenue, Room 27-139 CHS, Los Angeles, CA 90095-1740, USA
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