The clinical nature and formal diagnosis of premenstrual, postpartum, and perimenopausal affective disorders

Abstract

Various mood and anxiety disorders are more prevalent in reproductive-aged women, and appear to be linked to hormonal and reproductive events. Premenstrual affective disorders consist of premenstrual syndrome, premenstrual dysphoric disorder, and premenstrual exacerbation of mood or anxiety disorders. Postpartum affective disorders can range from postpartum "blues" to postpartum depression with or without psychosis, and also include anxiety disorders, such as panic disorder, generalized anxiety disorder, social phobia, and obsessive-compulsive disorder. In perimenopausal women, the vulnerability to mood and anxiety disorders is increased. All of these disorders share risk factors, and have etiologic features in common, such as exposure to the rise and fall of ovarian sex steroids. The following is a review of these syndromes and their etiology, diagnosis, and treatment.

Elevated serum copper levels in women with a history of post-partum depression

“…The diagnosis, etiology and treatment of PPD are issues of considerable current discussion [22,23]. Patients in this study had experienced their episodes of PPD months to years prior to their evaluation at the clinic, suggesting that serum Cu levels remain elevated long after the episode of PPD or, alternatively, are elevated in this population even before their episode of PPD.…”

Gender differences in antidepressant drug response

“…The rapid changes in the concentration of oestrogen, progesterone, luteinizing hormone (LH) and follicle stimulating hormone (FSH) observed at the onset of puberty, during the menstrual cycle, pregnancy, childbirth, and menopause are all associated with an increased risk of developing depression (Rapkin, Mikacich, Moatakef-Imani, & Rasgon, 2002). Moreover, hormone replacement therapy (HRT) using oestrogen may be an effective treatment for both perimenopausal and postnatal depression (Gregoire, Kumar, Everitt, Henderson, & Studd, 1996;Schmidt et al, 2000).…”

Inhibition of fear is differentially associated with cycling estrogen levels in women

“…[7][8][9][10] Women are more likely to report symptoms of depression and anxiety during premenstrual, postpartum and perimenopausal periods, when estrogen levels are low. [11][12][13][14][15][16] Moreover, neuroimaging studies show greater activation of neural networks involved in fear when women are scanned during the early follicular phase of their menstrual cycle (low estrogen levels) than when they are scanned midcycle (high estrogen levels). 17,18 Hence, natural fluctuations of estrogen across the reproductive cycle may factor into the disproportionate incidence of PTSD in women.…”