Reproductive cycle-associated mood symptoms in women with major depression and bipolar disorder

Johns Hopkins University, Baltimore, Maryland, United States
Journal of Affective Disorders (Impact Factor: 3.38). 05/2007; 99(1-3):221-9. DOI: 10.1016/j.jad.2006.08.013
Source: PubMed


We sought to determine the prevalence of, and association between, reproductive cycle-associated mood symptoms in women with affective disorders. We hypothesized that symptoms would correlate with each other across a woman's reproductive life span in both major depression (MDD) and bipolar I disorder (BP).
2412 women with, MDD or BP were asked standardized questions about mood symptoms prior to menstruation, within a month of childbirth and during perimenopause. Lifetime rates for each of these symptom types were determined and an odds ratio was calculated correlating each of the types with the others.
Of 2524 women with mood disorders, 67.7% reported premenstrual symptoms. Of those at risk, 20.9% reported postpartum symptoms and 26.4% reported perimenopausal symptoms. The rates did not differ between women with MDD and BP but were significantly different from women who were never ill. The symptoms were significantly correlated in women with MDD with odds ratios from 1.66 to 1.82, but were not in women with BP.
This is a secondary analysis of a sample that was collected for other purposes and is based upon retrospective reporting.
Reproductive cycle-associated mood symptoms were commonly reported in women with mood disorders and did not differ based on diagnosis. In MDD, but not BP, the occurrence of these symptoms was trait-like as the presence of one predicted the occurrence of the others. Further prospective study is required to clarify the determinants of this trait.

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    • "mood symptoms during past contraceptive use or third trimester to be risk factors for postpartum mood disorders (Bloch et al., 2005, 2006; Lee et al., 2007), which has been included as a new disorder under the 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013). However, there are limited studies on the association of premenstrual symptoms and the occurrence of reproductive cyclerelated mood symptoms with regard to a psychiatric diagnosis (Buttner et al., 2013; Payne et al., 2007). Most genetic studies on depression focus on neurotransmitters. "
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    ABSTRACT: Background Depression during pregnancy or after childbirth is the most frequent perinatal illness affecting women. We investigated the length distribution of a trinucleotide repeat in RAI1, which has not been studied in perinatal depression or in the Chinese population. Methods Cases (n=139) with confirmed diagnosis of clinical (major) depression related to pregnancy/postpartum were recruited from the outpatient clinic. Controls were patients who came to the obstetrics clinics and scored <7 on the Edinburgh Postnatal Depression Scale (EPDS) (n=540). Saliva samples for DNA analysis, demographic information and self-reported frequency of occurrence of various premenstrual/menstrual symptoms were collected from all participants. Genomic DNA was extracted from saliva and relevant region sequenced to determine the number of CAG/CAA repeats that encodes the polyglutamine tract in the N terminal of the protein. Difference between groups was assessed by chi-square analysis for categorical variables and analysis of variance for quantitative scores. Results Compared to control subjects, patients with perinatal depression reported more frequent mood changes, cramps, nausea, vomiting, diarrhoea, and headache during premenstrual/menstrual periods (p=0.000). For the RAI1 gene CAG/CAA repeat, there was a statistically significant difference in the genotypic distribution between cases and controls (p=0.031). There was also a statistically significant association between the 14-repeat allele and perinatal depression (p=0.016). Limitations Family history, previous mental illness, and physical and psychological symptoms during the premenstrual/menstrual periods were self-reported. EPDS screening was done only once for controls. Conclusions The RAI1 gene polyglutamine repeat has a different distribution in our population. The 14-repeat allele is associated with perinatal depression and more frequent experience of physical and psychological symptoms during menstrual period.
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    • "Future analysis with a restricted female control group assessed in regard to the menstrual cycle will be necessary for forming definitive conclusions . Fourth, it was reported that treated women with BPD do not seem to have menstruation-related mood symptoms (Payne et al., 2007; Shivakumar et al., 2008; Sit et al., 2011). "
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    ABSTRACT: We examined a rapid-cycling bipolar disorder patient who demonstrated manic episode regularly at around day 7 of the menstrual cycle. We hypothesize that gonadal hormones may induce a state-dependent change in cerebral microstructure and function. Following this hypothesis, the serum levels of estradiol and progesterone were analyzed and diffusion tensor imaging data were examined between the manic and euthymic states of the patient. Estradiol levels increased in the late follicular phase at manic state when compared to the luteal or early follicular phase at euthymic state. DTI results showed that the patient had increased fractional anisotropy values at manic state in the bilateral nucleus accumbens (NAc) and its connected areas, which is a major projection field of the mesolimbic dopamine (DA) system, perhaps reflecting microstructural changes due to neuronal activation related to manic episodes. According to these results, we consider that the mesolimbic DA system of this patient has hypersensitivity to estradiol, and elevation of the estradiol level increases the activity of the dopaminergic system, which in turn may contribute to recurrent manic episodes. Our findings provide a clue for understanding how fluctuations in gonadal hormone may amplify or ameliorate the symptomatology of psychiatric disorders related to the menstrual cycle.
    Full-text · Article · Dec 2013
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    • "Biological differences between men and women in terms of neuroanatomy, neurochemistry, and reactivity to hormones have been unequivocally established (Cosgrove, Mazure, & Staley, 2007), highlighting a hormonal milieu in women that is quite distinct from men. In addition, women are unique in that they experience rapid hormonal shifts secondary to reproductive life stages such as menstruation, childbirth, and perimenopause which again may predispose them to mood symptoms at such times (Payne, Palmer, & Joffe, 2009; Payne et al., 2007). Biology is not the only explanatory factor for the disproportionate number of women experiencing depression, however , and women are much more likely than men to be subject to significant psychosocial stressors that may increase the risk of developing depression (Gulcur, 2000; Millaire, Bujold, Morency, & Gauthier, 2006; Stewart, 2006). "
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    ABSTRACT: Abstract From menarche to menopause, women are highly vulnerable to major depression. While biological and psychosocial differences between men and women have been established, the reason for the preponderance of depression in women has yet to be fully elucidated. Women may be predisposed to depressive illness because of biological factors related to brain structure, function, and the impact of reproductive life stages. They may also be at increased risk because they are differentially disadvantaged with respect to environmental stressors including interpersonal violence, socioeconomic instability, and caregiving burden, among others. However, not all women develop depression, nor do all individuals who suffer from adverse life events. This narrative review focuses on emerging research related to the interaction between sex, genetics, and environmental factors that may help offer clues about why some individuals suffer from depression, and why others may be resilient to this outcome. While many questions remain unanswered, the psychodynamic psychotherapist can use this information to help patients suffering from depression understand some of the complexities of the determinants of risk and resilience, with the goal of moving forward toward recovery.
    Full-text · Article · Dec 2013 · Psychodynamic Psychiatry
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