Article

Clinical Subtypes of Premenstrual Syndrome and Responses to Sertraline Treatment

Department of Obstetrics/Gynecology, the Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Obstetrics and Gynecology (Impact Factor: 5.18). 12/2011; 118(6):1293-300. DOI: 10.1097/AOG.0b013e318236edf2
Source: PubMed

ABSTRACT

To estimate response of diagnosis and symptom-based subtypes to sertraline treatment.
This was a secondary data analysis for women who were diagnosed with premenstrual syndrome (PMS) or premenstrual dysphoric disorder and treated in three National Institutes of Health-supported clinical trials (N=447). Three PMS subtypes were identified based on predominance of psychological, physical, or both symptom types. Scores for each symptom and a total premenstrual score at baseline and endpoint were calculated from daily symptom diaries. Change from baseline after three treated menstrual cycles (or endpoint if sooner) was estimated using linear regression models adjusted for baseline severity.
The PMS and premenstrual dysphoric disorder diagnoses improved similarly with sertraline relative to placebo, whereas symptom-based subtypes had differential responses to treatment. The mixed symptom subtype had the strongest response to sertraline relative to placebo (Daily Symptom Rating difference 33.80; 95% confidence interval [CI] 17.16-50.44; P<.001), and the physical symptom subtype had the poorest response to sertraline (Daily Symptom Rating difference 9.50; 95% CI -16.29 to 35.28; P=.470). Results based on clinical improvement (50% decrease from baseline) indicated that 8.3 participants in the mixed symptom subtype, 3.9 in the psychological subtype, and 7.1 in the physical subtype are needed to observe one woman in the subtype who would achieve clinical improvement.
The PMS and premenstrual dysphoric disorder diagnoses have similar response to sertraline treatment, but symptom-based subtypes have significantly different responses to this treatment. Mixed and psychological symptom subtypes improved whereas the physical symptom subtype did not improve significantly. Identifying the patient's predominant symptoms and their severity is important for individualized treatment and a possible response to a selective serotonin reuptake inhibitor.
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    • "A study of 476 women who had participated in PMS/PMDD studies with sertraline reported that sertraline was superior to placebo for women with prominent psychological symptoms (e.g. irritability), but was less effective for women with predominantly physical premenstrual symptoms[13]. Several other studies have confirmed the lack of efficacy of SSRIs for premenstrual headaches. "

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    • "The symptoms had to be relieved within four days of menstruation onset without recurrence until at least the 13th cycle day [3]. The PMS diagnoses were confirmed by prospective daily symptom ratings for 2-3 menstrual cycles during the screening period [15]. The control group was selected among women in the same age group who were admitted to our clinic for routine gynecological examination and volunteered to participate in the study. "
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    • ") and other group defending the existence of different subtypes of PMDD (Angst et al., 2001; Freeman et al., 2011; Landen and Eriksson, 2003), with prevailing symptoms of depression , irritability or emotional lability (Halbreich, 1995). We identified in this sample few socio-demographic correlates significantly associated with different subtypes of depression. "
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    ABSTRACT: BACKGROUND: Few studies have investigated symptomatic subtypes of depression and their correlates by gender. METHODS: Data are from the São Paulo Megacity Mental Health Survey. Symptom profiles of 1207 subjects (864 women; 343 men) based upon symptoms of the worst depressive episode in lifetime were examined through latent class analysis. Correlates of gender-specific latent classes were analyzed by logistic regression. RESULTS: For both men and women, a 3-class model was the best solution. A mild class was found in both genders (41.1% in women; 40.1% in men). Gender differences appeared in the most symptomatic classes. In women, they were labeled melancholic (39.3%) and atypical (19.5%), differing among each other in somatic/vegetative symptoms. The melancholic class presented inhibition and eating/sleeping symptoms in the direction of decreasing, whereas the atypical class had increased appetite/weight, and hypersomnia. For men, symptoms that differentiate the two most symptomatic classes were related to psychomotor activity: a melancholic/psychomotor retarded (40.4%) and agitated depression (19.6%). The highest between-class proportion of agitation and racing thoughts was found among men in the agitated class, with similarity to bipolar mixed state. LIMITATIONS: Analyses were restricted to those who endorsed questions about their worst lifetime depressive episode; the standardized assessment by lay interviewers; the small male sample size. CONCLUSIONS: The construct of depression of current classifications is heterogeneous at the symptom level, where gender different subtypes can be identified. These symptom profiles have potential implications for the nosology and the therapeutics of depression.
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