Premenstrual exacerbation of depression common

Virginia Commonwealth University mental health experts have found that women with depression commonly report fluctuations in their symptoms across the menstrual cycle — a key factor that may help physicians better evaluate and treat depressed women.

In the January issue of the journal Psychological Medicine, researchers found that of 433 premenopausal women with major depressive disorder, 64 percent reported a worsening of their depression in the five to 10 days prior to menses. Women reporting premenstrual exacerbation (PME) of symptoms were compared with those reporting no PME with regard to a number of characteristics.

The women who reported PME had a significantly longer duration of their current major depressive episode, compared with those who reported no PME – 30.7 months compared with 13.5 months. The women who reported PME were also older and had more general medical problems.

The women in the study are participants in a larger study funded by the National Institute of Mental Health called the Sequenced Treatment Alternatives to Relieve Depression or STAR*D. VCU is one of 14 regional centers around the United States involved in the STAR*D study.

Susan G. Kornstein, M.D., primary investigator for the STAR*D study at VCU and lead author on the PME study, said researchers across the country have collected data from more than 4,000 participants and are conducting several sub-studies and sub-analyses in various mental health areas.

“The STAR*D study will help set the standards of how we treat depression over the next decade,” said Kornstein, a professor of psychiatry and obstetrics-gynecology in the VCU School of Medicine. “Most women who have depression and most doctors who treat depression are unaware that symptoms of depression can fluctuate with the menstrual cycle.”

“Based on our findings, this type of symptom pattern is very common, especially in women who have chronic courses of depression,” she said. “Identifying the fluctuation of depressive symptoms in a woman’s menstrual cycle will help doctors better evaluate and treat women with depression.

“For example, if you start a depressed woman on antidepressant medication and she comes back a week later feeling worse, it may be because she is premenstrual now and not that it was the wrong choice of antidepressant,” Kornstein said.

Kornstein, who also is the executive director of the VCU Institute for Women’s Health and the VCU Mood Disorders Institute, said it is critical for researchers and physicians to understand and consider the effect of reproductive events on depression in women – including the menstrual cycle, pregnancy, the postpartum period and menopause.

“In recent years, we have learned a great deal about how depression affects women,” Kornstein said. “And we have learned there are important differences when evaluating and treating depressed women compared to depressed men.”

In the United States, depression is approximately twice as common in women as in men. More than 20 percent of women will experience depression in the course of their lifetime. The risk for depression in women is highest during the childbearing years. According to Kornstein, depression is usually treated with medications or psychotherapy – and many patients require both.

Researchers next will use the STAR*D data to examine differences in treatment response to various types of medications and psychotherapy between women who report premenstrual worsening of depression and those who do not.

Other institutions involved with the STAR*D study include the University of Texas Southwestern Medical Center; Massachusetts General Hospital; the University of California at Los Angeles; the University of Pittsburgh Medical Center; Columbia College of Physicians & Surgeons; the University of North Carolina; the University of California at San Diego, the University of Michigan; Vanderbilt University Medical Center; the Psychiatric Research Institute in Wichita, Kan.; the Northwestern University Medical School; Laureate Healthcare System in Tulsa, Okla.; and the Tuscaloosa Veterans Affairs Medical Center in Alabama.