S104. Ovarian Steroid Withdrawal Underlies Perimenstrual Worsening of Suicidality: Evidence From a Crossover Steroid Stabilization Trial

Eisenlohr‐Moul, Tory A.; Prinstein, Mitchell J.; Rubinow, David R.; Young, Steven L.; Walsh, Erin C.; Bowers, Savannah M; Girdler, Susan S.

doi:10.1016/j.biopsych.2018.02.995

Cited by 4 publications

(7 citation statements)

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“…Methods have been rudimentary, utilizing self-reported last menses and single hormone measures to examine phase effects on admissions for suicide attempt (vs. accidents or other ailments). Nonetheless, the preponderance of the evidence indicates elevated perimenstrual risk for suicidal ideation and behavior, and forthcoming longitudinal and experimental evidence from our laboratory also supports a role for the cyclical hormone changes in acute risk for daily suicidal ideation, planning, and intent (29). Given the evidence that the menstrual cycle may drive predictable changes in risk for suicide, it is critical to identify potential mechanisms (e.g., RDoC systems) of this cycling risk.…”

Section: Introductionmentioning

confidence: 58%

Suicide Risk and the Menstrual Cycle: a Review of Candidate RDoC Mechanisms

Owens

Eisenlohr‐Moul

2018

Curr Psychiatry Rep

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Purpose of review: Risk for suicidal behavior may fluctuate across the menstrual cycle. Here, we use the RDoC framework to review potential mechanisms by which the cycle may increase acute suicide risk. Findings: The menstrual cycle impacts the majority of RDoC constructs linked to suicide risk, particularly among hormone-sensitive women, such as those with premenstrual dysphoric disorder or premenstrual exacerbation of a psychiatric disorder. Despite this, there are no published studies examining suicidal ideation, planning, or behavior longitudinally across the cycle. Summary: More work is needed to understand how hormone sensitivity may relate to both trait and state suicide risk. Intensive multilevel investigations of cyclical hormone effects on suicide risk through specific RDoC mechanisms are suggested. This is a fertile research area and may provide key insights regarding the mechanisms of acute suicide risk.

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Section: Introductionmentioning

confidence: 58%

Suicide Risk and the Menstrual Cycle: a Review of Candidate RDoC Mechanisms

Owens

Eisenlohr‐Moul

2018

Curr Psychiatry Rep

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“…Yet it deserves mention that these suggested research directions should be considered in the context of many other highly salient factors that are beyond the scope of this review. For example, the acute stress-response risk model suggested herein should be considered in the context of biological sex, particularly given adolescent girls' increased experience of social stress, greater biological and emotional reactivity to interpersonal stress (Rose & Rudolph 2006, Stroud et al 2017, and emerging data suggesting unique biological factors among females (i.e., circulating reproductive hormones) that may modulate stress-response systems (see Eisenlohr-Moul et al 2018b). Adolescent suicide also must be considered in the context of cultural factors, such as race, ethnicity, and religiosity, that are remarkably relevant but often neglected determinants of suicidal outcomes (Goldston et al 2008).…”

Section: Discussionmentioning

confidence: 99%

Adolescent Suicide as a Failure of Acute Stress-Response Systems

Miller

Prinstein

2019

Annu. Rev. Clin. Psychol.

137

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Suicide is the second leading cause of death worldwide for adolescents. Despite decades of research on correlates and risk factors for adolescent suicide, we know little about why suicidal ideation and behavior frequently emerge in adolescence and how to predict, and ultimately prevent, suicidal behavior among youths. In this review, we first discuss knowledge regarding correlates, risk factors, and theories of suicide. We then review why adolescence is a period of unique vulnerability, given changing biology and social network reorganization. Next, we present a conceptual model through which to interpret emerging findings in adolescent suicide research. We suggest that a promising area for future research is to examine adolescent suicide as a failure of biological responses to acute stress in the proximal moments of a suicidal crisis. After reviewing initial evidence for this conceptualization, we review future directions for studies on adolescent suicide.

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“…If a hormone-withdrawal-sensitive subtype of PMDD does exist, it could also signal increased risk during other periods of life when ovarian steroid withdrawal or deprivation also occurs, especially postpartum and the late menopause transition (Schiller et al ., 2013; Schmidt et al ., 2015). Experimental work should examine whether prevention of cyclical hormone withdrawal might uniquely benefit these patients (Eisenlohr-Moul et al ., 2018 a ).…”

Section: Discussionmentioning

confidence: 99%

“…Given that GnRH agonists reliably suppress hormone change, which is the widely-accepted pathophysiological trigger for PMDD (Schmidt et al ., 1998), this would seem to point to an alternative pathophysiology in some cases, such as sensitivity to hormone withdrawal or deprivation (e.g. see Eisenlohr-Moul et al ., 2018 a , 2018 b ). It is possible that unique risk processes underpin different subtypes of PMDD, which may help to inform treatment development and selection.…”

Section: Introductionmentioning

confidence: 99%

“…(2017)]. Consistent with previous work (e.g. Bancroft et al ., 1994; Dawson et al ., 2018; Eisenlohr-Moul et al ., 2018 a , 2018 b ), we also hypothesized that, especially for depressive symptoms, one trajectory group would show a late offset of symptoms, with symptoms arising at any point in the luteal phase but remitting more slowly or incompletely in the menstrual and postmenstrual weeks.…”

Section: Introductionmentioning

confidence: 99%

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Are there temporal subtypes of premenstrual dysphoric disorder?: using group-based trajectory modeling to identify individual differences in symptom change

et al. 2019

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BackgroundPremenstrual dysphoric disorder (PMDD) is a new Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 diagnosis characterized by the cyclical emergence of emotional and physical symptoms in the luteal phase of the menstrual cycle, with symptom remission in the follicular phase. Converging evidence highlights the possibility of distinct subtypes of PMDD with unique pathophysiologies, but temporal subgroups have yet to be explored in a systematic way.MethodsIn the current work, we use group-based trajectory modeling to identify unique trajectory subgroups of core emotional and total PMDD symptoms across the perimenstrual frame (days −14 to +9, where day 0 is menstrual onset) in a sample of 74 individuals prospectively diagnosed with DSM-5 PMDD.ResultsFor the total daily symptom score, the best-fitting model was comprised of three groups: a group demonstrating moderate symptoms only in the premenstrual week (65%), a group demonstrating severe symptoms across the full 2 weeks of the luteal phase (17.5%), and a group demonstrating severe symptoms in the premenstrual week that were slow to resolve in the follicular phase (17.5%).ConclusionsThese trajectory groups are discussed in the context of the latest work on the pathophysiology of PMDD. Experimental work is needed to test for the presence of possible pathophysiologic differences in trajectory groups, and whether unique treatment approaches are needed.

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S104. Ovarian Steroid Withdrawal Underlies Perimenstrual Worsening of Suicidality: Evidence From a Crossover Steroid Stabilization Trial

Cited by 4 publications

References 0 publications

Suicide Risk and the Menstrual Cycle: a Review of Candidate RDoC Mechanisms

Suicide Risk and the Menstrual Cycle: a Review of Candidate RDoC Mechanisms

Adolescent Suicide as a Failure of Acute Stress-Response Systems

Are there temporal subtypes of premenstrual dysphoric disorder?: using group-based trajectory modeling to identify individual differences in symptom change

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