Premenstrual Exacerbations of Mood Disorders: Findings and Knowledge Gaps

Abstract Purpose of Review In contrast to premenstrual dysphoric disorder (PMDD), premenstrual exacerbations (PMEs) of ongoing mood disorders are understudied. The aim of this review is to describe diagnostic issues, epidemiology, underlying mechanisms, and treatment for PME in unipolar depression and bipolar disorder, and to discuss clinical and research implications. Recent Findings Community-based and clinical studies estimate that in women with mood disorders around 60% report PME, while some women with bipolar disorder also show symptom exacerbations around ovulation. In general, PME predicts a more severe illness course and an increased burden. While heightened sensitivity to fluctuations of sex hormone levels across the menstrual cycle appears to contribute to PME and PMDD, the overlap of their underlying biological mechanisms remains unclear. Beneficial treatments for PMDD show less or no efficacy in PME. Pharmacological treatments for PME in mood disorders predominantly seem to profit from adjustable augmentation of treatment dosages during the luteal phase for the underlying disorder. However, the evidence is sparse and mainly based on earlier small studies and case reports. Summary Previous research is mainly limited by the lack of a clear differentiation between PME and PMDD comorbidity with mood disorders. More systematic research with uniformly defined and prospectively assessed subgroups of PME in larger epidemiological and clinical samples is needed to receive reliable prevalence estimates and information on the clinical impact of PME of mood disorders, and to uncover underlying mechanisms. In addition, larger randomized controlled trials are warranted to identify efficacious pharmacological and psychotherapeutic treatments for affected women.

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Mood Disorders

10.2310/fm.1021 ◽

2017 ◽

Author(s):

Hasan A Baloch ◽

Jair C. Soares

Keyword(s):

Bipolar Disorder ◽

Mood Disorders ◽

Gray Matter ◽

Affective Disorders ◽

Unipolar Depression ◽

Diagnosis And Treatment ◽

Bipolar Spectrum ◽

Manic Symptoms ◽

Lifetime History ◽

History Of

Affective disorders are among the most common disorders in psychiatry. They are generally classified according to the persistence and extent of symptoms and by the polarity of these symptoms. The two poles of the affective spectrum are mania and depression. Bipolar disorder is characterized by the presence of the mania or hypomania and often depression. Unipolar depression is defined by depression in the absence of a lifetime history of mania or hypomania. These differences are not merely categorical but have important implications for the prognosis and treatment of these conditions. Bipolar disorder, for example, is better treated using mood-stabilizing medication, whereas unipolar depression responds optimally to antidepressant medications. In addition, prognostically, unipolar depression may sometimes be limited to one episode in a lifetime, whereas bipolar disorder is typically a lifelong condition. The course of both conditions, however, is often chronic, and frequently patients can present with unipolar depression only to later develop manic symptoms. A thorough understanding of both conditions is therefore required to treat patients presenting with affective symptomatology. This chapter discusses the epidemiology, etiology and genetics, pathogenesis, diagnosis, and treatment of unipolar depression and bipolar disorder. Figures illustrate gray matter differences with lithium use and the bipolar spectrum. Tables list the pharmacokinetics of commonly used antidepressants and medications commonly used in the treatment of bipolar disorder. This review contains 2 figures, 2 tables, and 136 references.

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Brain mechanisms in manic depression

Clinical Chemistry ◽

10.1093/clinchem/40.2.303 ◽

1994 ◽

Vol 40 (2) ◽

pp. 303-308 ◽

Cited By ~ 20

Author(s):

B J Carroll

Keyword(s):

Bipolar Disorder ◽

Mood Disorders ◽

Unipolar Depression ◽

Depressive Illness ◽

Manic Depression ◽

Manic Depressive Illness ◽

Manic Depressive ◽

Clinical Presentations ◽

Genetic Mechanisms ◽

Activity Information

Abstract Manic depressive illness (bipolar disorder) is the mood disorder classically considered to have a strong biological basis. During manic depressive cycles, patients show dramatic fluctuations of mood, energy, activity, information processing, and behaviors. Theories of brain function and mood disorders must deal with the case of bipolar disorder, not simply unipolar depression. Shifts in the nosologic concepts of how manic depression is related to other mood disorders are discussed in this overview, and the renewed adoption of the Kraepelinian "spectrum" concept is recommended. The variable clinical presentations of manic depressive illness are emphasized. New genetic mechanisms that must be considered as candidate factors in relation to this phenotypic heterogeneity are discussed. Finally, the correlation of clinical symptom clusters with brain systems is considered in the context of a three-component model of manic depression.

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Pediatric mania: a developmental subtype of bipolar disorder?

Acta Neuropsychiatrica ◽

10.1017/s0924270800035596 ◽

2000 ◽

Vol 12 (3) ◽

pp. 131-131

Author(s):

J. Biederman ◽

E. Mick ◽

S.V. Faraone ◽

Th. Spencer ◽

T. Wilens ◽

...

Keyword(s):

Bipolar Disorder ◽

Substance Use ◽

Substance Use Disorders ◽

Case Reports ◽

Response To Treatment ◽

Systematic Research ◽

List Type ◽

Childhood Onset ◽

Ongoing Controversy

Despite ongoing controversy, the view that pediatric mania is rare or non-existent has been increasingly challenged not only by case reports but also by systematic research. This research strongly suggests that pediatric mania may not be rare but that it may be difficult to diagnose. Since children with mania are likely to become adults with bipolar disorder, the recognition and characterization of childhood-onset mania may help identify a meaningful developmental subtype of bipolar disorder worthy of further investigation. The major difficulties that complicate the diagnosis of pediatric mania include:- its pattern of comorbidity may be unique by adult standards, especially its overlap with ADHD, aggression and conduct disorder;- its overlap with substance use disorders;- its association with trauma and adversity;- its response to treatment is atypical by adult standards.These issues will be reviewed in the presentation.

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Mood Disorders

10.2310/neuro.1021 ◽

2010 ◽

Author(s):

Hasan A Baloch ◽

Jair C. Soares

Keyword(s):

Bipolar Disorder ◽

Mood Disorders ◽

Gray Matter ◽

Affective Disorders ◽

Unipolar Depression ◽

Diagnosis And Treatment ◽

Bipolar Spectrum ◽

Manic Symptoms ◽

Lifetime History ◽

History Of

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The relationship between creativity and mood disorders

Dialogues in Clinical Neuroscience ◽

10.31887/dcns.2008.10.2/ncandreasen ◽

2008 ◽

Vol 10 (2) ◽

pp. 251-255 ◽

Cited By ~ 8

Keyword(s):

Bipolar Disorder ◽

Mood Disorder ◽

Mood Disorders ◽

Comparison Group ◽

Unipolar Depression ◽

Mental Illnesses ◽

Optimal Sample ◽

Multiple Challenges ◽

The Relationship

Research designed to examine the relationship between creativity and mental illnesses must confront multiple challenges. What is the optimal sample to study? How should creativity be defined? What is the most appropriate comparison group? Only a limited number of studies have examined highly creative individuals using personal interviews and a noncreative comparison group. The majority of these have examined writers. The preponderance of the evidence suggests that in these creative individuals the rate of mood disorder is high, and that both bipolar disorder and unipolar depression are quite common. Clinicians who treat creative individuals with mood disorders must also confront a variety of challenges, including the fear that treatment may diminish creativity. In the case of bipolar disorder, however, it is likely that reducing severe manic episodes may actually enhance creativity in many individuals.

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Childhood maltreatment and adult medical morbidity in mood disorders: comparison of unipolar depression with bipolar disorder

The British Journal of Psychiatry ◽

10.1192/bjp.2018.178 ◽

2018 ◽

Vol 213 (5) ◽

pp. 645-653 ◽

Cited By ~ 5

Author(s):

Georgina M. Hosang ◽

Helen L. Fisher ◽

Karen Hodgson ◽

Barbara Maughan ◽

Anne E. Farmer

Keyword(s):

Bipolar Disorder ◽

Mood Disorders ◽

Dose Response ◽

Childhood Maltreatment ◽

Child Neglect ◽

Unipolar Depression ◽

Medical Illness ◽

Medical Burden ◽

The Impact ◽

Medical Morbidity

BackgroundThe medical burden in mood disorders is high; various factors are thought to drive this pattern. Little research has examined the role of childhood maltreatment and its effects on medical morbidity in adulthood among people with unipolar depression and bipolar disorder.AimsThis is the first study to explore the association between childhood maltreatment and medical morbidity in bipolar disorder and in unipolar depression, and examine whether the impact of abuse and neglect are distinct or combined.MethodThe participants consisted of 354 psychiatrically healthy controls, 248 participants with recurrent unipolar depression and 72 with bipolar disorder. Participants completed the Childhood Trauma Questionnaire and received a validated medical history interview.ResultsAny type of childhood maltreatment, child abuse and child neglect were significantly associated with the medical burden in bipolar disorder, but not unipolar depression or for controls. These associations worked in a dose–response fashion where participants with bipolar disorder with a history of two or more types of childhood maltreatment had the highest odds of having a medical illness relative to those without such history or those who reported one form. No such significant dose–response patterns were detected for participants with unipolar depression or controls.ConclusionsThese findings suggest that childhood maltreatment may play a stronger role in the development of medical illnesses in individuals with bipolar disorder relative to those with unipolar depression. Individuals who had been maltreated with a mood disorder, especially bipolar disorder may benefit most from prevention and intervention efforts surrounding physical health.Declaration of interestNone.

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Mood disorders – review of structural MRI studies

Acta Neuropsychiatrica ◽

10.1046/j.1601-5215.2003.00052.x ◽

2003 ◽

Vol 15 (6) ◽

pp. 368-380 ◽

Cited By ~ 8

Author(s):

E. Serap Monkul ◽

Gin S. Malhi ◽

Jair C. Soares

Keyword(s):

Bipolar Disorder ◽

Mood Disorders ◽

Unipolar Depression ◽

Structural Mri ◽

Common Finding ◽

Brain Abnormalities ◽

Prefrontal Cortical ◽

Manual Search ◽

Structural Abnormalities ◽

Prospective Longitudinal

Background:Mood disorders are related to considerable morbidity and mortality, and although there is little doubt that they are brain-based disorders, their neural correlates still remain elusive. A neuro-anatomic model of mood regulation comprising the prefrontal cortex, amygdala-hippocampus complex, thalamus, basal ganglia, and connections among these areas has been proposed.Objective:We reviewed the evidence for regional brain abnormalities in bipolar disorder, and attempted to integrate available findings into a comprehensive pathophysiological model of illness.Methods:A computerized Medline Ovid search was conducted for the period 1966–2002, and complemented by a manual search of bibliographical references from recent reviews. Articles meeting specified criteria were included.Results:Hyperintense lesions in cortical and subcortical regions are the most consistently reported and widely studied structural abnormalities. Smaller prefrontal cortical volume is a common finding in bipolar disorder and unipolar depression. Enlarged amygdala (in bipolar disorder) and smaller hippocampus (in unipolar depression) have been reported by several groups. Decreased volumes (in unipolar depression) and increased or unaltered volumes (in bipolar disorder) of striatal structures have been reported.Conclusions:Bipolar and unipolar mood disorders are associated with detectable structural brain abnormalities. The histopathology underlying such anatomical changes remains to be elucidated. To reach more definitive conclusions about neuroanatomical changes that take place during the course of mood disorders, prospective longitudinal studies are needed. Also, integration with functional imaging is necessary in order to elucidate the relevance of identified structural abnormalities.

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A 20-year multi-follow-up of hallucinations in schizophrenia, other psychotic, and mood disorders

Psychological Medicine ◽

10.1017/s0033291712002206 ◽

2012 ◽

Vol 43 (6) ◽

pp. 1151-1160 ◽

Cited By ~ 32

Author(s):

V. M. Goghari ◽

M. Harrow ◽

L. S. Grossman ◽

C. Rosen

Keyword(s):

Bipolar Disorder ◽

Psychiatric Disorders ◽

Mood Disorders ◽

Schizoaffective Disorder ◽

Young Patients ◽

Unipolar Depression ◽

Diagnostic Feature ◽

Longitudinal Course ◽

Prospective Longitudinal

BackgroundHallucinations are a major aspect of psychosis and a diagnostic feature of both psychotic and mood disorders. However, the field lacks information regarding the long-term course of hallucinations in these disorders. Our goals were to determine the percentage of patients with hallucinations and the relationship between hallucinations and recovery, and work attainment.MethodThe present study was a prospective evaluation of the 20-year trajectory of hallucinations in 150 young patients: 51 schizophrenia, 25 schizoaffective, 25 bipolar with psychosis, and 49 unipolar depression. The patients were studied at an index phase of hospitalization for hallucinations, and then reassessed longitudinally at six subsequent follow-ups over 20 years.ResultsThe longitudinal course of hallucinations clearly differentiated between schizophrenia and bipolar disorder with psychosis, and suggested some diagnostic similarities between schizophrenia and schizoaffective disorder, and between bipolar disorder and schizoaffective disorder and depression. Frequent or persistent hallucinatory activity over the 20-year period was a feature of 40–45% of schizophrenia patients. The early presence of hallucinations predicted the lack of future periods of recovery in all patients. Increased hallucinatory activity was associated with reduced work attainment in all patients.ConclusionsThis study provides data on the prospective longitudinal course of hallucinations, which were previously unavailable to the field, and are one of the key features of psychosis in major psychiatric disorders. This information on the clinical course of major psychiatric disorders can inform accurate classification and diagnosis.

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Mood Disorders in ICD-11 and DSM-5

Die Psychiatrie ◽

10.1055/s-0038-1670833 ◽

2013 ◽

Vol 10 (01) ◽

pp. 24-29 ◽

Cited By ~ 8

Author(s):

M. Maj

Keyword(s):

Bipolar Disorder ◽

Anxiety Disorders ◽

Mood Disorders ◽

Unipolar Depression ◽

Mixed States ◽

Paper Briefly ◽

Schizoaffective Disorders ◽

Dsm 5 ◽

The Past

SummaryThis paper briefly reviews how the ICD-11 and DSM-5 are going to handle the various continua existing in the area of mood disorders. The two systems will address the continua between “normal” elation and hypomania, between unipolar depression and bipolar disorder, and between anxiety disorders and depression in a more consistent way than in the past, while there will be differences in the characterization of mixed states and schizoaffective disorders. A major weakness of both systems will be the fact that the boundary between “normal” sadness and depression will not be based on a solid empirical evidence.

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DSM

10.1093/med/9780197574430.003.0007 ◽

2021 ◽

pp. 101-122

Author(s):

Edward Shorter

Keyword(s):

Bipolar Disorder ◽

Mental Disorders ◽

Mood Disorders ◽

Diagnostic Criteria ◽

Unipolar Depression ◽

Discussion Group ◽

Statistical Manual ◽

Diagnostic And Statistical Manual ◽

Manic Depressive ◽

The Revolution

The decline of psychopharmacology began with the growing view that many of the diagnoses in the official Diagnostic and Statistical Manual of Mental Disorders (DSM) did not really exist. The paper that began the revolution in diagnosis in psychiatry was written by a discussion group of residents led by John Feighner. Then the DSM was drawn up using the diagnostic criteria known as the “Feighner criteria,” which Fritz Henn admitted were based on Emil Kraepelin's work. The various editions of Kraepelin's textbook in the 1900s lumped all the mood disorders into one big basin: manic-depressive insanity. In contrast, the ideas of Karl Leonhard provided a revolutionary recasting of the major illnesses that dismissed the Kraepelinian illness pool and implemented a strict division on the basis of polarity: unipolar depression vs. bipolar disorder.

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