Mood changes correlate to changes in brain serotonin precursor trapping in women with premenstrual dysphoria
Introduction
Premenstrual dysphoric disorder (PMDD) is characterized by the cyclical occurrence of disabling mood symptoms in the luteal (premenstrual) phase of the menstrual cycle, with a profound impact on the afflicted woman and her near environment (American Psychiatric Association, 1994). The cardinal symptoms are irritability, depressed mood, affective lability and impaired impulse control, all of which are effectively alleviated by drugs increasing brain serotonin activity (Eriksson, 1999). Randomised trials have shown selective serotonin reuptake inhibitors (SSRIs) to be effective pharmacological treatments in about 60% of women with PMDD (Rapkin, 2003), and these drugs are considered the most effective treatment known at present (Dimmock et al., 2000). This implies that reduced serotonergic activity might be one symptom-provoking factor in premenstrual dysphoria, supporting the “serotonin hypothesis” of the pathogenesis of the disorder, namely that worsening of self-rated premenstrual mood symptoms is associated with a concomitant decline in brain serotonin activity (Steiner and Pearlstein, 2000, Parry, 2001, Eriksson et al., 2002). Positron emission tomography (PET) was used to measure brain trapping of 11C-5-hydroxy-l-tryptophan (11C-5-HTP), which when radiolabeled in the metabolically stable β-position is a marker of aromatic l-amino-acid decarboxylase (AAAD) activity (Bjurling et al., 1990, Hartvig et al., 1992, Hartvig et al., 1993, Lindner et al., 1997). Associations between changes in cardinal symptoms of PMDD and changes in brain 11C-5-HTP trapping from early (mid-follicular) to late (premenstrual) in the menstrual cycle were investigated. Primary end-points were associations between changes in the core symptoms of premenstrual dysphoria, “irritable” and “depressed mood”, and changes in 11C-5-HTP trapping in a large brain region representing the “whole brain” and in specific areas of the forebrain that are known to be involved in affective disorders (Ågren and Reibring, 1994, Brody et al., 2001, Davidson, 2002).
Section snippets
Participants
Eight women were recruited for the study, one through our gynecological admittance, and seven from subjects participating in a treatment trial published elsewhere (Landen et al., 2001). Inclusion criteria were: fulfillment of criteria A–C of PMDD as described in DSM-IV (American Psychiatric Association, 1994); fulfillment of criterion D by showing cyclicity of the core symptoms “irritability” and/or “depressed mood” in two of three visual analogue scale (VAS)-rated cycles. The inclusion
Results
The median scores for the cardinal mood variables (VAS) and their changes are shown in Table 1. Associations of changes in VAS ratings of mood symptoms with changes in serotonin precursor trapping (11C-5-HTP) between menstrual cycle phases showed a consistent pattern, with several very strong correlations (Table 2). For negative mood symptoms, negative correlations were found for all ROIs, and for positive mood variables, the corresponding correlations were all positive. The core symptoms of
Discussion
This is the first report of measurements in vivo of changes in brain 11C-5-HTP trapping in relation to mood and physical symptoms in women with premenstrual dysphoria. The most prominent findings were strong and consistent associations between changes in self-rated mood scores and changes in 11C-5-HTP trapping in a region of interest representing the whole brain, in frontal cortex regions and in most striatal regions. Changes in the core symptoms of premenstrual dysphoria, irritability and
Acknowledgments
We thank the staff of the Uppsala Imanet AB (previously Uppsala University PET Centre) for providing the possibilities for performing this study. The help of Dr. Mikael Klingert, MD, consultant psychiatrist, in patient state evaluation is appreciated. We are grateful for the expert statistical help from the statisticians Lars Berglund, Johan Bring and Johan Lindbäck. We thank Assoc. Professor Per Olof Osterman and the Clinical Advisory Board, the PET Foundation of the County of Uppsala, the
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