At a time when our appreciation of the biological basis of so many neuropsychiatric disorders has surged forward, our understanding of the etiology of hormone-mediated mood disorders, like premenstrual dysphoric disorder (PMDD), has lagged behind.  Several interesting articles here explore the structural and functional changes in the brains of women who suffer from PMDD.  

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Ruta Nonacs, MD PhD





Resting-state functional connectivity in women with PMDD.

Petersen N, Ghahremani DG, Rapkin AJ, Berman SM, Wijker N, Liang L, London ED.  Transl Psychiatry. 2019 Dec 11;9(1):339. 

Women with PMDD have different intrinsic network dynamics in the left executive control network compared to healthy controls.

Brain Structure and Function in Women with Comorbid Bipolar and Premenstrual Dysphoric Disorder.

Syan SK, Minuzzi L, Smith M, Costescu D, Allega OR, Hall GBC, Frey BN.  Front Psychiatry. 2018 Jan 10;8:301.

Women in the BD-PMDD group displayed greater disruption in biological rhythms and more subthreshold depressive and anxious symptoms through the menstrual cycle compared to other groups. Women with BD and comorbid PMDD display a distinct clinical and neurobiological phenotype of BD, which suggests differential sensitivity to endogenous hormones.



No articles this week



Patient decision aids for antidepressant use in pregnancy: a pilot randomised controlled trial in the UK.

Khalifeh H, Molyneaux E, Brauer R, Vigod S, Howard LM.  BJGP Open. 2019 Dec 10. Free Article

Patient decision aids (PDAs) can improve shared decision-making for complex health decisions but no evidence-based PDAs exist for antidepressant use in pregnancy.

Course of mental health and mother-infant bonding in hospitalized women with threatened preterm birth.

Hanko C, Bittner A, Junge-Hoffmeister J, Mogwitz S, Nitzsche K, Weidner K.  Arch Gynecol Obstet. 2019 Dec 11.

Women hospitalized for risk of preterm birth showed significantly higher rates of depression, anxiety, and stress during inpatient treatment in pregnancy, as well as 6 weeks postpartum compared to women without pregnancy complications.

Maternal schizophrenia and adverse birth outcomes: what mediates the risk?

Vigod SN, Fung K, Amartey A, Bartsch E, Felemban R, Saunders N, Guttmann A, Chiu M, Barker LC, Kurdyak P, Brown HK.  Soc Psychiatry Psychiatr Epidemiol. 2019 Dec 6. 

Elevated risks of preterm birth, SGA, and low Apgar scores in infants of women with schizophrenia are partly explained by potentially modifiable factors such as smoking and illicit drug use, suggesting opportunities for targeted intervention.

Depression and suicidal ideation in pregnancy: exploring relationships with insomnia, short sleep, and nocturnal rumination.

Kalmbach DA, Cheng P, Ong JC, Ciesla JA, Kingsberg SA, Sangha R, Swanson LM, O’Brien LM, Roth T, Drake CL.

Sleep Med. 2019 Jul 22;65:62-73.

Depressed women were at greater odds of sleep onset insomnia (OR = 2.80), sleep maintenance insomnia (OR = 6.50), high nocturnal rumination (OR = 6.50), and negative perinatal-focused rumination (OR = 2.70). Suicidal ideation was associated with depression (OR = 3.64) and negative perinatal-focused rumination (OR = 3.50).

Association of antepartum depression, generalized anxiety, and posttraumatic stress disorder with infant birth weight and gestational age at delivery.

Gelaye B, Sanchez SE, Andrade A, Gómez O, Coker AL, Dole N, Rondon MB, Williams MA.  J Affect Disord. 2020 Feb 1;262:310-316.

Women with antepartum generalized anxiety (32.6% prevalence) had higher odds of LBW (adjusted odds ratio (OR)=1.47; 95%CI: 1.10-1.95) and were more likely to deliver small for gestational age (OR = 1.39; 95%CI: 1.01-1.92) infants compared to those without anxiety. Compared to those without PTSD, women with PTSD (34.5%) had higher odds of delivering preterm (OR = 1.28; 95%CI: 1.00-1.65) yet PTSD was not associated with LBW nor gestational age at delivery. Women with antepartum depression (26.2%) were at no increased risk of delivering a preterm, low-birth-weight or small-for-gestational-age infant.



No articles this week



Preeclampsia as a risk factor for postpartum depression and psychosis: a systematic review and meta-analysis.

Caropreso L, de Azevedo Cardoso T, Eltayebani M, Frey BN.  Arch Womens Ment Health. 2019 Dec 4.

Eight of the 13 studies found an association between preeclampsia and depression which demonstrated a higher severity of depressive symptoms postpartum in women with PE.

Predictors and outcomes of suicidal ideation during peripartum period.

Martini J, Bauer M, Lewitzka U, Voss C, Pfennig A, Ritter D, Wittchen HU.  J Affect Disord. 2019 Oct 1;257:518-526. 

Peripartum suicidal ideation or PS was indicated by n?=?15 out of 306 women. Risk for PS was predicted by a history of suicide attempt (OR?=?17.84, 95%CI: 4.61-69.05), living together with the partner (OR?=?0.14, 95%CI: 0.03-0.63), and social support (OR?=?0.35, 95%CI: 0.13-0.91). As compared to women with no PS, infants of women with PS presented lower scores in neuropsychological development at 18 months.

Development of postpartum depression interventions for mothers of premature infants: a call to target low-SES NICU families.

Hall EM, Shahidullah JD, Lassen SR.  J Perinatol. 2019 Aug 22.



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Men and women respond differently to antipsychotic drugs.

Seeman MV.  Neuropharmacology. 2020 Feb. Review.

Pharmacotherapy for schizophrenia in postmenopausal women.

González-Rodríguez A, Seeman MV.  Expert Opin Pharmacother. 2018 Jun;19(8):809-821. 

All antipsychotic medications have adverse effects, which become more prominent for women at the time of menopause. Estrogen modulators may not help all symptoms of schizophrenia but are, nevertheless, relatively safe and, when used as adjuncts, help to keep antipsychotic doses low, thus reducing the side effect burden. 



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