This week there are a few interesting articles on PMDD.  In the last edition of the DSM, PMDD was included as a formal diagnosis.  Several articles look at instruments which can be used to diagnose PMDD according the the DSM-5 criteria.


Ruta Nonacs, MD PhD


Obstetrical, pregnancy and socio-economic predictors for new-onset severe postpartum psychiatric disorders in primiparous women.

Meltzer-Brody S, Maegbaek ML, Medland SE, Miller WC, Sullivan P, Munk-Olsen T.

Psychol Med. 2017 Jan 23:1-15.

Complications occurring during pregnancy and delivery can increase the risk for PPD.

Oxytocin Mediates a Calming Effect on Postpartum Mood in Primiparous Mothers.

Niwayama R, Nishitani S, Takamura T, Shinohara K, Honda S, Miyamura T, Nakao Y, Oishi K, Araki-Nagahashi M.Breastfeed Med. 2017 Jan 19. [Epub ahead of print]

Oxytocin release associated with breastfeeding was associated with a temporary anxiolytic-like calming effect in postpartum mood.

Longitudinal suicidal ideation across 18-months postpartum in mothers with childhood maltreatment histories.

Muzik M, Brier Z, Menke RA, Davis MT, Sexton MB.  J Affect Disord. 2016 Nov 1;204:138-45.

In a group of women with child maltreatment, suicidal ideation was reported most commonly at 4-months (37%) and remained at approximately 25% for the duration of the 18 month study.

The Impact of Antenatal Depression on Perinatal Outcomes in Australian Women.

Eastwood J, Ogbo FA, Hendry A, Noble J, Page A; Early Years Research Group (EYRG)..  PLoS One. 2017 Jan 17;12(1).  Free Article

In this large prospective study, over 17000 women were followed prospectively across pregnancy.  The prevalence of maternal depressive symptoms during pregnancy was 7.0%.  Depression during pregnancy

was associated with a higher odds of low birth weight (AOR = 1.7)] and birth before 37 weeks (AOR = 1.3). Women with antenatal depression were also six times as likely to develop postpartum depression.

Using the Edinburgh Postnatal Depression Scale for women and men-some cautionary thoughts.

Matthey S, Agostini F.  Arch Womens Ment Health. 2017 Jan 11.

Possible limitations of the EPDS include: ambiguous items, exclusion of certain types of distress, scoring inconsistencies, low positive predictive value, and validation against a questionable gold-standard.  While the EPDS is a useful screening tool, users must be aware that it, like other measures, has limitations.

Bioidentical Estrogen for Menopausal Depressive Symptoms: A Systematic Review and Meta-Analysis.

Whedon JM, KizhakkeVeettil A, Rugo NA, Kieffer KA.  J Womens Health (Larchmt). 2017 Jan;26(1):18-28.

This systematic review demonstrated that bioidentical hormone replacement therapy has no clear benefit in treating depressive symptoms in menopausal women.

Premenstrual Dysphoric Disorder Without Comorbid Psychiatric Conditions: A Systematic Review of Therapeutic Options.

Sepede G, Sarchione F, Matarazzo I, Di Giannantonio M, Salerno RM.  Clin Neuropharmacol. 2016 Sep-Oct;39(5):241-61.

Based on the data presented in this review, the best therapeutic option in the treatment of adult PMDD patients free of other psychiatric symptoms are selective serotonin reuptake inhibitor antidepressants and low doses of oral estroprogestins.

Development of a screening instrument to assess premenstrual dysphoric disorder as conceptualized in DSM-5.

Aperribai L, Alonso-Arbiol I, Balluerka N, Claes L.  J Psychosom Res. 2016 Sep;88:15-20.

The Premenstrual Dysphoric Disorder Questionnaire for DSM-5 is a 25-item questionnaire to assess PMDD.

Toward the Reliable Diagnosis of DSM-5 Premenstrual Dysphoric Disorder: The Carolina Premenstrual Assessment Scoring System (C-PASS).

Eisenlohr-Moul TA, Girdler SS, Schmalenberger KM, Dawson DN, Surana P, Johnson JL, Rubinow DR.  Am J Psychiatry. 2017 Jan 1;174(1):51-59.

The C-PASS is a standardized scoring system for making DSM-5 PMDD diagnoses using two or more months of daily symptom ratings with the Daily Record of Severity of Problems (DRSP).

Making Strides to Simplify Diagnosis of Premenstrual Dysphoric Disorder.

Epperson CN, Hantsoo LV.  Am J Psychiatry. 2017 Jan 1;174(1):6-7.

Commentary on the above listed article.

Prenatal Psychostimulant and Antidepressant Exposure and Risk of Hypertensive Disorders of Pregnancy.

Newport DJ, Hostetter AL, Juul SH, Porterfield SM, Knight BT, Stowe ZN.  J Clin Psychiatry. 2016 Nov;77(11):1538-1545.

After adjustment for possible confounders, hypertension was associated with use of psychostimulants (odds ratio [OR] = 6.11) and serotonin-norepinephrine reuptake inhibitors (SNRI) (OR = 2.57).   Hypertension risk was not associated with prenatal selective serotonin reuptake inhibitor exposure or other psychiatric disorders.

Disadvantaged Women: The Impact of Comorbid Posttraumatic Stress Disorder.

Grote NK, Katon WJ, Russo JE, Lohr MJ, Curran M, Galvin E, Carson K.  J Clin Psychiatry. 2016 Nov;77(11):1527-1537.

Over the 18-month follow-up, those with comorbid PTSD participating in the collaborative MOMCare program (n = 48), versus MSS-Plus (intensive public health Maternity Support Services, n = 58), showed greater improvement in depression severity, PTSD severity, and level of functioning.  Higher rates of depression response and remission and increased use of mental health services and antidepressant medication was observed in the MOMCare group.


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