Rapid response to fluoxetine in women with premenstrual dysphoric disorder.

Behavioral Endocrinology Branch, National Institute of Mental Health, National Institutes of Health, Department of Health & Human Services, Bethesda, Maryland, USA.
Depression and Anxiety (Impact Factor: 4.29). 06/2012; 29(6):531-40. DOI: 10.1002/da.21959
Source: PubMed

ABSTRACT Selective serotonin reuptake inhibitors (SRIs) relieve irritability within days in women with premenstrual dysphoric disorder (PMDD); however, the effects on other affective symptoms in PMDD remain to be demonstrated.
We performed hourly ratings in women with PMDD to test the specificity of the therapeutic effects of SRIs and to determine whether the kinetics of these effects differ from those of the symptom offset accompanying menses. Twelve women with PMDD received fluoxetine (20 mg daily) during the luteal phase of the menstrual cycle. Twelve other women with PMDD received no treatment. Outcome measures included a visual analogue scale completed hourly before and after either the start of SRIs or at menses-onset in the untreated women and the premenstrual tension syndrome (PMTS) scale completed daily. Data were analyzed by ANOVA-R.
Hourly VAS scores significantly improved after SRI in irritability as well as sadness, anxiety, and mood swings. Compared with the symptomatic pretreatment baseline, PMTS scores significantly improved on the second day after the start of SRI (p < .01). An identical time course of symptom improvement occurred after both SRI and menses-onset.
These data document that the rapid response to SRI was not limited to irritability. The similar kinetics in the remission of PMDD after SRIs and after menses-onset suggest both a phenotype reflecting the relative capacity to rapidly change affective state, and a possible therapeutic mechanism by which SRIs recruit this endogenous capacity to change state, normally expressed around menses-onset in women with PMDD.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Depression, anxiety, and irritability are the three most studied symptoms of premenstrual dysphoric disorder (PMDD). This study aimed to assess the premenstrual exacerbation of these symptoms and their role in the diagnosis or functional impairment of PMDD. We recruited women with PMDD not undergoing any treatment and control subjects from the community. The diagnosis of PMDD was based on a positive score on the Premenstrual Symptoms Screening Tool and confirmed by psychiatric interviews and questionnaire follow-up for three menstrual cycles. A total of 67 women with PMDD and 75 control subjects participated the survey and reach the final analysis. They complete the Center for Epidemiological Studies, the Chinese Version of the Buss-Durkee Hostility Inventory-Short Form, and the Penn State Worry Questionnaire in both the premenstrual and follicular phases. Women with PMDD, but no controls, demonstrate the premenstrual exacerbation of these three symptoms. Depression was the most prominent feature of the PMDD diagnosis while irritability was most frequently associated with functional impairment. Depression and irritability should be properly evaluated and treated among women with PMDD.
    The International Journal of Psychiatry in Medicine 01/2013; 46(1):39-55. DOI:10.2190/PM.46.1.d · 0.81 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Clinical research has demonstrated a significant sex difference in the occurrence of depressive disorders. Beginning at pubertal onset, women report a higher incidence of depression than men. Women are also vulnerable to the development of depressive disorders such as premenstrual dysphoric disorder, postpartum depression, and perimenopausal depression. These disorders are associated with reproductive stages involving changes in gonadal hormone levels. Specifically, female depression and female affective behaviors are influenced by estradiol levels. This review argues two major mechanisms by which estrogens influence depression and depressive-like behavior: through interactions with neurotrophic factors and through an influence on the serotonergic system. In particular, estradiol increases brain derived neurotrophic factor (BDNF) levels within the brain, and alters serotonergic expression in a receptor subtype-specific manner. We will take a regional approach, examining these effects of estrogens in the major brain areas implicated in depression. Finally, we will discuss the gaps in our current knowledge of the effects of estrogens on female depression, and the potential utility for estrogen receptor modulators in treatment for this disorder.
    Progress in Neuro-Psychopharmacology and Biological Psychiatry 10/2014; 54:13–25. DOI:10.1016/j.pnpbp.2014.05.009 · 4.03 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In the field of bipolar disorders, the fifth edition of the DSM has clarified the definition of manic mood, which includes irritability and expansiveness. This elevated mood is associated with increased goal-directed activity or energy. A full manic episode that emerges during an antidepressant treatment (e.g., medication, electroconvulsive therapy) is now sufficient evidence for a manic episode diagnosis and therefore for a bipolar disorder I diagnosis. If so a mood-stabilizer treatment is required. The DSM-5 authors call for more caution in case of hypomanic episodes induced by antidepressant treatment, especially if only one or two symptoms are present. On the other hand, if there are psychotic features, the episode is, by definition, manic. Several studies have judged the bereavement exclusion criteria irrelevant to fulfil the diagnosis of major depressive episode, that is why this exclusion criteria has disappeared from DSM-5. This might help for a better management of major depressive episode in case of mourning. The lack of consensual definition of mixed state led to the suppression of the mixed episode in this new edition of the DSM. It is however possible to specify the mixed features in manic, hypomanic and depressive episodes. This decision is in coherence with Emil Kraepelin's inheritance. In fact, Kraepelin himself described several mixed states, essentially as transition states between the two main clinical pictures (mania and depression) of the manic-depressive illness. In this perspective, clinical pictures such as agitated depression, dysphoric manic or hypomanic episodes can be reconsidered and one can hope that studies will be conducted to deepen the knowledge of those episodes from a clinical, physiopathological and therapeutic point of view. Finally the premenstrual dysphoric disorder has moved from the appendix B (for the research) of the DSM-IV to the “diagnostic criteria and codes” (section II) of the DSM-5. This disorder is quite frequently associated with bipolar disorder II whose prognosis it worsens while complicating its therapeutic management. In the paper, the premenstrual dysphoric disorder is described on an historical, clinical, physiopathological and therapeutic level, within the limits of current knowledge about this uncommon psychiatric syndrome. Its DSM-5 diagnostic criteria are also summarized and commented upon. This official entry of the premenstrual dysphoric disorder in the DSM-5 shows the willingness of the American Psychiatric Association to incorporate uncommon psychiatric syndromes in its diagnostic classification.
    Annales Médico-psychologiques revue psychiatrique 10/2014; DOI:10.1016/j.amp.2014.08.010 · 0.15 Impact Factor


Available from
Jun 3, 2014