Chronobiological Basis of Female-Specific Mood Disorders

Abstract

Women have twice the incidence of major depression compared with men. They are prone to develop episodes of depression during times of reproductive hormonal change at puberty, with use of oral contraceptives, during the premenstrual phase of the menstrual cycle, postpartum and during the perimenopause (see review: Parry 1995a). WirzJustice (1995) In women, hormonal changes associated with the reproductive cycle may provoke affective changes in predisposed individuals. Examples include depression associated with oral contraceptives (Parry and Rush 1979), the luteal phase of the menstrual cycle (Hamilton et al. 1984;Endo et al. 1978;Halbreich and Endicott 1985), the postpartum period (Parry and Hamilton 1990), and menopause (Winokur 1973). Sex differences in the rates of depression begin to appear after puberty (Weissman et al. 1984;Angold et al. 1998), a time of major change in the neuroendocrine reproductive axis. From this time onward, women have a greater lifetime risk for major depression than men. Women predominate with respect to unipolar depression (Weissman et al. 1984), the depressive subtype of bipolar illness (Angst 1978), and cyclical forms of affective illness such as rapid cycling manic-depressive illness (Wehr 1984) and seasonal affective disorder (Rosenthal et al. 1984). Furthermore, the risk for major depression in both men and women appears to be increasing in recent generations (Weissman et al. 1984;Klerman and Weissman 1989).The fluctuation of ovarian steroids during specific phases of the reproductive cycle may bear some relationship to the particular vulnerability of women for mood disorders. The ovarian hormones could exert their effects on mood directly or indirectly by their effect on neurotransmitter, neuroendocrine, or circadian systems (McEwen and Parsons 1982;Albers 1981;Albers et al. 1981;Thomas and Armstrong 1989; Parry 1995a,b). Although each of these systems has been implicated in the pathogenesis of depressive illness, the circadian basis of these disorders has received the least attention. We have designed our studies with their particular chronobiological focus because the predisposition of women for major depression has not been investigated systematically with respect to the interaction of Chronobiology, Women and Depression S103 the unique cyclic reproductive neuroendocrine axis in women and circadian physiology. Although chronobiological disturbances have been described in depression (Kripke et al. 1978;Wehr and Goodwin 1980), the characterization of chronobiological disturbances in reproductive-related mood disorders in women remains to be elucidated. Below we review the circadian rhythm abnormalities that we have observed in premenstrual dysphoric disorder, pregnancy and postpartum depression and menopause. As reproductive hormones modulate the synchrony or coherence between different components of the circadian system (Thomas and Armstrong 1989), we hypothesize that these changing hormones during the premenstrual, postpartum and menopausal periods may destabilize circ...

Gender-Specific Associations of Short Sleep Duration With Prevalent and Incident Hypertension

“…Given the mean age of our female participants falling around the menopausal period (Ϸ55 years), we can speculate that the periods marking shifts in the reproductive stages, such as menopause, are particularly vulnerable times for women, because they are associated with major hormonal turmoil and psychosocial stresses that may, in turn, lead to adverse health outcomes. 27 For example, in our sample of female participants, the prevalence of depression cases was higher among women reporting short duration of sleep (Յ5 hours per night) than in other subgroups. In addition, as shown in our descriptive analyses, the distribution of correlates of short sleep duration that have the potential to affect hypertension risk was different between genders and may have partially contributed to the observed associations.…”

Benefits and costs of artificial nighttime lighting of the environment

“…For example, light has been employed (often during the daytime) to treat seasonal affective disorder, depression in women with pre-menstrual disorder (Parry and Newton 2001), to regulate menstrual cycles (Lin et al 1990), and to improve activity levels of patients with dementia (Holman 2010) by manipulating the onset of melatonin production. Less tangible is an apparent sense of wellbeing humans may instinctively feel in lit environments, even where their physical wellbeing may be unaffected or harmed, possibly a response evolved due to increased predation risk in dark areas in naturally lit environments (Packer et al 2011).…”

Premenstrual Dysphoric Disorder: Burden of Illness and Treatment Update

“…49 Women with PMDD have abnormal melatonin secretion and other circadian system abnormalities. 56 It has been proposed that women with PMDD have altered affective information processing and regulation during the luteal phase, with abnormal activation patterns in specific brain regions. 55 Imaging studies have demonstrated altered functional magnetic resonance imaging responses to negative and positive stimuli in the orbitofrontal cortex, amygdala and ventral striatum in women with PMDD compared with control subjects.…”

“…188 It has been proposed that sleep deprivation and light therapy may decrease premenstrual dysphoria by correcting abnormal circadian rhythms found in women with PMDD. 56 Although a crossover study reported that evening bright light for 2 premenstrual weeks decreased depression and tension, 189 a meta-analysis of the few existing trials suggested a small effect size for bright light therapy.…”