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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Several developments in serotonin neuropharmacology have implications for psychiatric disorders and have already begun to impact their treatment. Selective inhibitors of serotonin uptake, which enhance serotonergic function by preventing the removal of serotonin from the synaptic cleft via the membrane transporter, have been introduced for the treatment of depression and may be effective in other disorders. Precursor loading can increase serotonin concentrations in the synaptic cleft, and tryptophan--which has been available in health food stores and drug stores--had become increasingly used for self-medication of depression, insomnia, and premenstrual syndrome. Conversion to serotonin is not the major metabolic pathway for tryptophan, and large increases in other tryptophan metabolites (such as quinolinic acid, a substance that is excitotoxic at high concentrations) accompany small increases in extracellular serotonin. The recent epidemic of the eosinophilia-myalgia syndrome associated with tryptophan now appears due to a trace contaminant in the product from a single manufacturer. A major advance in serotonin pharmacology has been the elucidation of serotonin receptor heterogeneity. At least seven receptor subtypes (5-HT1A, 5-HT1B, 5-HT1C, 5-HT1D, 5-HT2, 5-HT3, 5-HT4) have been identified in brain. Direct-acting agonists and antagonists can have selective affinity for specific receptor subtypes. Selective activation of 5-HT1A receptors seems to cause anxiolytic and possibly antidepressive effects. Selective antagonists of 5-HT2 or 5-HT3 receptors may be useful in treating anxiety and schizophrenia. Drugs that enhance serotonergic function suppress aggression in animals, but the specific receptor subtypes involved are not known. The advances being made in serotonin pharmacology will help define the role of this brain neurotransmitter in psychiatric and other disorders and can be expected to lead to further therapeutic advances.
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PMID:Role of serotonin in therapy of depression and related disorders. 167 51

In a study of 144 women, mainly self-designated PMS sufferers, the premenstrual depression experienced was, apart from its shorter duration, quantitatively and qualitatively similar to major depressive disorder for a substantial proportion of subjects. The associations with previous history of depression were complex: the severity of premenstrual depression was related to previous history of postnatal depression, whereas its duration (i.e., whether it persisted through longer) was related to a history of treatment with antidepressants. Two independent dimensions are proposed. (i) A menstrual cycle-related factor which in vulnerable women can results in severe and disabling premenstrual dysphoria, and which may be aetiologically related to a subgroup of postnatal depression. (ii) In a minority of women a more general propensity for depressive illness evidence as a tendency for any premenstrual depression to be prolonged.
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PMID:The relationship between perimenstrual depressive mood and depressive illness. 177 24

The Authors consider particularly significant the studies on premenstrual syndrome (PMS) which point out a relationship between affective disorders and premenstrual depression indicated by several Authors as useful pattern for studying depression. Considering this results, the Authors studied a sample of women suffering from PMS sharing it on the basis of subjective depressive feelings. The Authors obtained two groups which were submitted to a further clinical study in order to point out specific personality and psychopathologies. The Authors used the Premenstrual Assessment Form (PAF) and the Daily Ratings Form (DR). The results showed that premenstrual depression can be considered a marker of the seriousness of the syndrome and it is closely linked to anxiety symptomatology. In women with PMS the Authors did not point out important psychopathological aspects, therefore the PMS is not evidence for psychiatric illness.
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PMID:[Mood changes and premenstrual syndrome]. 180 32

Cyclic progestin therapy has been widely advocated as an adjunct to postmenopausal estrogen replacement therapy to reduce the risk of endometrial carcinoma. Acceptance of this approach, however, appears to have preceded detailed evaluation of possible adverse side effects of progestins that could result in patient noncompliance. We evaluated the nonmenstrual physical and psychological side effects of oral medroxyprogesterone acetate given in conjunction with transdermal estrogen in two groups of women with previous hysterectomy and oophorectomy. Twenty-four women with prospectively documented severe premenstrual syndrome (PMS) before surgery and 24 women with no such history of adverse premenstrual changes received transdermal estrogen 100 micrograms on days 1-25 and either oral medroxyprogesterone acetate 10 mg daily or an identical placebo (days 12-25) in a randomized, double-blind, cross-over design. Mood and physical symptoms were monitored prospectively, using daily self-ratings on the Daily Symptoms Checklist. The Beck Depression Inventory and Premenstrual Tension Self-Rating Scale were completed on day 24. At the study's completion, the patients were asked which treatment period they preferred. Paired comparisons did not reveal any significant differences, and preference for treatment was equally divided between medroxyprogesterone acetate and placebo. We conclude that addition of medroxyprogesterone acetate 10 mg/day for 14 days to cyclic transdermal estrogen therapy (days 1-25) produces no consistent adverse physical or psychological effects on women for one cycle of treatment, regardless of their PMS history.
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PMID:A randomized, double-blind, placebo-controlled, cross-over trial to assess the side effects of medroxyprogesterone acetate in hormone replacement therapy. 182 50

This double-blind, randomized, crossover study compared the efficacy and safety of danazol (100 mg twice daily) with matching placebo in the treatment of severe premenstrual syndrome. Nineteen patients were randomly allocated to receive danazol for 3 months followed by placebo, and 18 to receive treatment in the reverse order. Assessments of overall condition showed improvement to be statistically significantly more likely with danazol than with placebo (P less than 0.001) after 3 months' treatment. Furthermore, daily visual analogue scale assessments demonstrated statistically significantly better premenstrual scores with danazol in comparison to placebo for breast discomfort, irritability, depression, anxiety, mood swings, crying, depressed libido and abdominal swelling. It is concluded that danazol provides effective and generally well tolerated treatment for severe premenstrual syndrome.
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PMID:Low dose danazol in the treatment of the premenstrual syndrome. 185 64

Depression, chronic fatigue, and premenstrual syndrome often coexist in women seeking treatment for premenstrual distress. A reliable diagnosis can be made by prospectively rating symptoms for two cycles, taking a careful history, performing physical and gynecologic examinations, and obtaining basic laboratory test results and a psychosocial evaluation. Appropriate dietary, hormonal, or antidepressant treatment provided in a caring and competent manner can benefit many women suffering from this otherwise disabling/condition.
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PMID:Depression, chronic fatigue, and the premenstrual syndrome. 187 20

Eleven patients with prospectively documented premenstrual depression were given 100 mg atenolol or placebo daily to suppress melatonin secretion during the symptomatic premenstrual phase of the menstrual cycle. There was no significant improvement in mood following treatment with atenolol vs. placebo. These findings suggest that bright light may exert antidepressant effects in patients with premenstrual syndrome through mechanisms other than melatonin suppression and that atenolol does not appear to be a viable treatment modality for the majority of patients with premenstrual depression.
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PMID:Atenolol in premenstrual syndrome: a test of the melatonin hypothesis. 187 26

The NIMH Diagnostic Interview Schedule (n = 43), and the Hopkins Symptom Checklist and Weissman Social Adjustment Scale (n = 35) was administered to assess the prevalence of psychiatric disorders and psychosocial maladjustment present in women seeking treatment in a multidisciplinary Premenstrual Syndrome Clinic. We found a 67 percent lifetime prevalence of DIS/DSM-III psychiatric disorders: 50 percent Major Affective Disorder (primarily Depression), 53 percent Anxiety Disorder (primarily Phobias or Generalized Anxiety Disorder), and 40 percent Psychosexual Dysfunction (notably Inhibited Sexual Desire or Excitement). Our group had significantly greater Major Depression, Dysthymia, and any one psychiatric disorder compared with female general population samples. Two-thirds of women with premenstrual symptoms had true Premenstrual Syndrome. In our sample, social maladjustment as well as psychiatric symptomatology was significantly greater than in normals and closer to that in psychiatric out-patient norms, and was independent of cycle phase. Presence or absence of PMS, social maladjustment and sexual dysfunction was each not significantly different in women with or without psychiatric disorder.
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PMID:Sexual dysfunction, social maladjustment, and psychiatric disorders in women seeking treatment in a premenstrual syndrome clinic. 189 58

Posttubal ligation syndrome consists of various menstrual disorders including premenstrual syndrome (PMS). 78 patients aged 30-49 years, who were previously diagnosed with PMS and seeking treatment and who had a parity of 1-6, were studied. 25 women aged 26-49 comprised the tubal sterilization (TS) group with TS, and 11 tubal cauterizations. 43 females aged 20-47 made up the nonsterilized groups. Serum estradiol assay indicated intraassay and interassay coefficient variation of 4 and 8.1%. Serum progesterone assay showed intraassay and interassay coefficient variation of 5.8 and 10%. The total testosterone assay calibration range was 15-110 ng/dl with intraassay and interassay coefficient variation of 5.2 and 92%. Thyroid stimulating hormone (TSH) plasma levels were determined with radioimmunoassay utilizing a double antibody. The intraassay and interassay coefficients of variation were 2.7-7.9% and 2.6-9.4%, respectively. Total levothyroxine assay yielded a calibration range of 1-24 mcg/dl. The PMS symptoms were not significantly different between the sterilized and nonsterilized groups, not did the levels of hormones differ during the luteal and follicular phases except for a significantly lower follicular estradiol level in the TS group (50.4 +or- 24.1 pg/ml) as opposed to the nonsterilized group (81.7 +or- 69.1 pg/ml). Luteal levels of estradiol in the whole sample were positively associated with luteal depression, aggression, and physical symptoms. This was limited to depression in the nonsterilized group. Most researchers concluded that PMS was not linked to TS, although some found a 36 and 93% higher incidence after TS which was attributed to the damage to vascular supplies by TS. This controversy could be solved by a prospective study with evaluation before and after TS. The present data did not indicate a connection between TS and PMS or hormonal changes linked with TS in PMS patients.
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PMID:Prevalence and severity of premenstrual changes after tubal sterilization. 194 95

The extent to which the high discontinuation rate for oral contraceptives is due to adverse effects of mood, well-being and sexuality is explored, taking into account early studies on high dose combined and sequential pills, recent studies on low-dose combined and triphasics, experimental design factors, effects of OCs on free androgen levels, psychosocial factors and reasons for choosing or stopping pills, effects on depressive illness, premenstrual syndrome, sexuality, and possible mechanisms for direct effects of steroids on mood and sexuality. Study design is complicated by selection of early or late oral contraceptive users, types of controls, and unknown confounding factors such as reason for choice of pills, effect of a reliable contraceptive on the sexual relationship, prior history of depression and premenstrual tension. Furthermore virtually all topics reviewed here resulted in inconsistent or contradictory findings, making a case for individual variation and subgroups of women with different responses regarding the end point being examined. Examples include whether progestogen alter female sexual desire or male attraction; and whether rising or falling free testosterone levels affect sexual response. Factors affecting experimental design include culture, language, life-cycle, type of relationship, personal qualities affecting contraceptive choice, manner of eliciting reports of side effects, steroid dose, whether ovulation was blocked, initial or established pill-use, possibility of missed pills, and type of controls. Current pill users seem to discontinue for depression and low libido less frequently than did users of higher dose pills, and severity scores of adverse effects are lower. Premenstrual and other cyclic events may be altered in timing, and premenstrual symptoms are relieved in most women, but worsened in some who take pills. It is likely that women with depressive and premenstrual complaints tend to discontinue pills, leaving the remaining users with greater reported well-being. There are conflicting reports on improved and adverse effects of pills on sexuality and libido, implying that pill choice confounds the results, that libido cycles are altered, or that subtle effects of steroids on sexual response are overwhelmed by psychosocial factors in some women. Studies on the effects of steroids on biological sexual responses, and metabolism of serotonin and other neurotransmitter related to depression have not yielded definite conclusions.
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PMID:The effects of oral contraceptives on well-being and sexuality. 207 4


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