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Premenstrual Symptoms and Perimenopausal Depression

CITATION:  Richards, M., Rubinow, D. R., Daly, R. C.  and Schmidt, P. J. (2006). Premenstrual Symptoms and Perimenopausal Depression. The American Journal of Psychiatry, 163(1), 133-137. 

ABSTRACT:  

Objective: The role of ovarian steroids in both premenstrual dysphoria and perimenopausal depression has led to the suggestion that these conditions represent expressions of the same underlying disorder. Premenstrual mood symptoms were evaluated in women with perimenopause-related depression.

Method: Self-reports and daily symptom ratings during one menstrual cycle were examined in 70 depressed perimenopausal women attending a menopause clinic and 35 nondepressed perimenopausal women.

Results: Twenty-six percent of the depressed and 9% of the nondepressed women reported premenstrual symptoms. Thirty-one percent of the depressed and 20% of the nondepressed women met criteria for significant menses-related symptom cyclicity (at least a 30% increase in the average ratings of at least two of four measured negative mood symptoms in the premenstrual versus the postmenstrual week); 5 of these depressed women and none of the comparison subjects described premenstrual symptoms on self-reports. Finally, 21% of the depressed and 3% of the nondepressed women met criteria for premenstrual dysphoria (symptom cyclicity and at least moderate severity, with symptoms exceeding a minimum luteal symptom severity threshold of 2.5).

Conclusions: A higher-than-expected rate of menses-related symptom cyclicity and premenstrual dysphoria was observed in perimenopausal depressed women.  However, neither menses-related symptom cyclicity nor premenstrual dysphoria was an invariant accompaniment of perimenopausal depression. Additionally, the rate of premenstrual dysphoria was not predicted by initial self-reports.

References

1. Schmidt PJ, Nieman LK, Danaceau MA, Adams LF, Rubinow DR: Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome. N Engl J Med 1998; 338:209-216

2. Henshaw C, Foreman D, Belcher J, Cox J, O'Brien S: Can one induce premenstrual symptomatology in women with prior hysterectomy and bilateral oophorectomy? J Psychosom Obstet Gynaecol 1996; 17:21-28

3. Schmidt PJ, Nieman L, Danaceau MA, Tobin MB, Roca CA, Murphy JH, Rubinow DR:Estrogen replacement in perimenopause-related depression: a preliminary report.Am J Obstet Gynecol 2000; 183:414-420

4. Soares CD, Almeida OP, Joffe H, Cohen LS: Efficacy of estradiol for the treatment of depressive disorders in perimenopausal women: a double-blind, randomized, placebo-controlled trial. Arch Gen Psychiatry 2001; 58:529-534

5. Bromberger JT, Meyer PM, Kravitz HM, Sommer B, Cordal A, Powell L, Ganz PA, Sutton-Tyrrell K: Psychologic distress and natural menopause: a multiethnic community study. Am J Public Health 2001; 91:1435-1442

6. Freeman EW, Sammel MD, Liu L, Gracia CR, Nelson DB, Hollander L: Hormones and menopausal status as predictors of depression in women in transition to menopause. Arch Gen Psychiatry 2004; 61:62-70

7. Schmidt PJ, Haq N, Rubinow DR: A longitudinal evaluation of the relationship between reproductive status and mood in perimenopausal women. Am J Psychiatry 2004; 161:2238-2244

8. Maartens LWF, Knottnerus JA, Pop VJ: Menopausal transition and increased depressive symptomatology: a community based prospective study. Maturitas 2002; 42:195-200

9. Chim H, Tan BHI, Ang CC, Chew EMD, Chong YS, Saw SM: The prevalence of menopausal symptoms in a community in Singapore. Maturitas 2003; 41:275-282

10. Arpels JC: The female brain hypoestrogenic continuum from the premenstrual syndrome to menopause: a hypothesis and review of supporting data. J Reprod Med 1996; 41:633-639

11. Studd JWW, Watson NR, Montgomery J: Depression and the menopause (letter).BMJ 1990; 300:1653

12. Stewart DE, Boydell KM: Psychologic distress during menopause: associations across the reproductive cycle. Int J Psychiatry Med 1993; 23:157-162

13. Collins A, Landgren B-M: Reproductive health, use of estrogen and experience of symptoms in perimenopausal women: a population-based study. Maturitas 1995; 20:101-111

14. Novaes C, Almeida OP, de Melo NR: Mental health among perimenopausal women attending a menopause clinic: possible association with premenstrual syndrome?Climacteric 1998; 1: 264-270

15. Soares CN, Almeida OP: Depression during the perimenopause (letter). Arch Gen Psychiatry 2001; 58:306

16. Dennerstein L, Lehert P, Burger H, Dudley E: Mood and the menopausal transition. J Nerv Ment Dis 1999; 187:685-691

17. Harlow BL, Cohen LS, Otto MW, Spiegelman D, Cramer DW: Prevalence and predictors of depressive symptoms in older premenopausal women: the Harvard Study of Mood and Cycles. Arch Gen Psychiatry 1999; 56:418-124

18. Smith RNJ, Studd JWW, Zamblera D, Holland EFN: A randomised comparison over 8 months of 100 mg and 200 mg twice weekly doses of transdermal oestradiol in the treatment of severe premenstrual syndrome. Br J Obstet Gynaecol 1995; 102:475-484

19. Watson NR, Savvas M, Studd JWW, Garnet T, Baber RJ: Treatment of severe premenstrual syndrome with oestradiol patches and cyclical oral norethisterone.Lancet 1989; 2:730-732

20. Watson NR, Studd JWW, Savvas M, Baber RJ: The long-term effects of estradiol implant therapy for the treatment of premenstrual syndrome. Gynecol Endocrinol 1990; 4:99-107

21. Dhar V, Murphy BEP: Double-blind randomized crossover trial of luteal phase estrogens (Premarin) in the premenstrual syndrome (PMS).Psychoneuroendocrinology 1990; 15:489-493

22. Dejong R, Rubinow DR, Roy-Byrne PP, Hoban MC, Graver GN, Post RM:Premenstrual mood disorder and psychiatric illness. Am J Psychiatry 1985; 142:1359-1361

23. Endicott J: The menstrual cycle and mood disorders. J Affect Disord 1993; 29:193-200

24. Stout AL, Steege JF, Blazer DG, George LK: Comparison of lifetime psychiatric diagnoses in premenstrual syndrome clinic and community samples. J Nerv Ment Dis 1986; 174:517-22

25. Yonkers KA: The association between premenstrual dysphoric disorder and other mood disorders. J Clin Psychiatry 1997; 58:19-25

26. Kim DR, Gyulai L, Freeman EW, Morrison MF, Baldassano C, Dube B:Premenstrual dysphoric disorder and psychiatric comorbidity. Arch Womens Ment Health 2004; 7:37-47

27. Soules MR, Sherman S, Parrott E, Rebar R, Santoro N, Utian W, Woods N: Stages of Reproductive Aging Workshop (STRAW). J Womens Health Gend Based Med 2001; 10:843-848

28. Frasure-Smith N, Lesperance F, Talajic M: Depression following myocardial infarction: impact on 6-month survival. JAMA 1993; 270:1819-1825

29. Krishnan KRR: Biological risk factors in late life depression. Biol Psychiatry 2002; 52:185-192

30. Halbreich U, Endicott J, Schacht S, Nee J: The diversity of premenstrual changes as reflected in the Premenstrual Assessment Form. Acta Psychiatr Scand 1982; 65:47-65

31. Smith MJ, Schmidt PJ, Rubinow DR: Operationalizing DSM-IV criteria forPMDD: selecting symptomatic and asymptomatic cycles for research. J Psychiatr Res 2003; 37:75-83

32. Ramcharan S, Love EJ, Pick GH, Goldfien A: The epidemiology of premenstrual symptoms in a population-based sample of 2650 urban women: attributable risk and risk factors. J Clin Epidemiol 1992; 45:377-392

33. Campbell EM, Peterkin D, O'Grady K, Sanson-Fisher R: Premenstrual symptoms in general practice patients: prevalence and treatment. J Reprod Med 1997; 42:637-646

34. Hylan TR, Sundell K, Judge R: The impact of premenstrual symptomatology on functioning and treatment-seeking behavior: experience from the United States, United Kingdom, and France. J Womens Health Gend Based Med 1999; 8:1043-1052

35. Gehlert S, Hartlage S: A design for studying the DSM-IV research criteria of premenstrual dysphoric disorder. J Psychosom Obstet Gynaecol 1997; 18:36-44

36. Deuster PA, Adera T, South-Paul J: Biological, social, and behavioral factors associated with premenstrual syndrome. Arch Fam Med 1999; 8:122-128

37. Halbreich U, Borenstein J, Pearlstein T, Kahn LS: The prevalence, impairment, impact, and burden of premenstrual dysphoric disorder (PMS/PMDD).Psychoneuroendocrinology 2003; 28:1-23

38. Angst J, Sellaro R, Stolar M, Merikangas KR, Endicott J: The epidemiology of perimenstrual psychological symptoms. Acta Psychiatr Scand 2001; 104:110-116

39. Wittchen H-U, Becker E, Lieb R, Krause P: Prevalence, incidence and stability of premenstrual dysphoric disorder in the community. Psychol Med 2002; 32:119-132

40. Steiner M, Macdougall M, Brown E: The Premenstrual Symptoms Screening Tool (PSST) for clinicians. Arch Womens Ment Health 2003; 6:203-209

41. Gallant SJ, Popiel DA, Hoffman DM, Chakraborty PK, Hamilton JA: Using daily ratings to confirm premenstrual syndrome/late luteal phase dysphoric disorder, part II: what makes a "real" difference? Psychosom Med 1992; 54:167-181

42. Abraham S, Mira M: Psychosocial forces in premenstrual syndrome, in Premenstrual, Postpartum, and Menopausal Mood Disorders. Edited by Demers LM, McGuire JL, Phillips A, Rubinow DR. Baltimore, Urban and Schwarzenberg, 1989, pp 65-80

43. Richardson SJ: The biological basis of the menopause. Baillieres Clin Endocrinol Metab 1993; 7:1-16

44. te Velde ER, Scheffer GJ, Dorland M, Broekmans FJ, Fauser BCJM:Developmental and endocrine aspects of normal ovarian aging. Mol Cell Endocrinol 1998; 145:67-73

45. Sherman BM, West JH, Korenman SG: The menopausal transition: analysis of LH, FSH, estradiol, and progesterone concentrations during menstrual cycles of older women. J Clin Endocrinol Metab 1976; 42:629-636

46. Sherman BM, Korenman SG: Hormonal characteristics of the human menstrual cycle throughout reproductive life. J Clin Invest 1975; 55:699-706

47. Yonkers KA, White K: Premenstrual exacerbation of depression: one process or two? J Clin Psychiatry 1992; 53:289-292

48. Praschak-Rieder N, Willeit M, Neumeister A, Hilger E, Stastny J, Thierry N, Lenzinger E, Kasper S: Prevalence of premenstrual dysphoric disorder in female patients with seasonal affective disorder. J Affect Disord 2001; 63:239-242