About this Research Topic
Menstrually Related Mood Disorders (MRMDs) are characterized by affective, cognitive, and physical symptoms occurring in the luteal phase of the menstrual cycle. Clinically, the diagnostic nomenclature has evolved over the years from Premenstrual Syndrome (PMS) to Late Luteal Phase Dysphoric Disorder (LLPDD). Finally, Premenstrual Dysphoric Disorder has become a recognized diagnostic entity in the Diagnostic and Statistical Manual Fifth Edition (DSM-5). It has been moved from being a category under the appendix (conditions deserving further study) in DSM-4 to the section under Depressive disorders.
The relationship of MRMDs with mood disorders (including bipolar disorders and major depression) has been studied extensively with conflicting findings. High rates of co-occurrence, premenstrual worsening of symptoms of mood disorders being diagnosed as MRMD, as well as the significant impact of MRMD on the severity, course, and treatment response have been reported. MRMD and Bipolar disorder II (more common in women) have been consistently reported to co-occur more often than Bipolar I. On the other hand, the link with other disorders remains virtually unexplored. With advances in research, understanding the neurobiology of MRMDs has made some progress. Genetic susceptibility, the role of neurosteroids, HPA axis abnormalities, and structural and functional differences in the brain have been put forth as some of the contributors to MRMD. The role of trauma has also been reported in many studies, however, it is not specific to MRMDs but is applicable to other psychiatric disorders.
Newer treatment approaches in MRMDs have also been parallelly developed with an improved understanding of the neurobiology of MRMD. Selective serotonin reuptake inhibitors are considered the first line of pharmacological interventions. Evidence for other antidepressant drugs like Serotonin Norepinephrine reuptake inhibitors, Mirtazapine is still lacking. The role of estrogen, progesterone, and its derivatives has been researched with results indicating their efficacy in MRMDs. Psychological treatments like Cognitive Behavior Therapy (CBT) have been extensively researched in the treatment of MRMD and the efficacy remains conflicting. Evidence for use of newer third wave therapies including mindfulness-based approaches is limited. Despite the modest effect of CBT, it is still considered as the first line of treatment more so for mild symptoms. Complementary and alternate medicine approaches for MRMD including yoga, herbal medicines, acupuncture have been studied but still, there is skepticism about their efficacy.
The diagnosis of PMDD has been criticized for lack of diagnostic validity, over pathologizing the normal physiological phenomenon, lack of cultural validation as well as criticism from feminist groups for subjectification of womens’ bodies. There is a need to conduct rigorous studies to establish diagnostic validity across different cultures with prospective ratings. Prospective studies on the course of PMDD and its diagnostic stability are necessary to understand this complex association, both from the biological and psychological points of view. The role of trauma has also been reported in many studies, however, it is not specific to MRMDs but is applicable to other psychiatric disorders. Would trauma-informed therapies have a potential role in the management of MRMDs? With advances in understanding neurobiology, how have the newer treatment approaches, including pharmacological, psychological, and complementary and alternate medicine approaches, have evolved?
This Research Topic aims to receive articles focusing on research on MRMDs. The focus of research may include diagnostic validity, course, and outcome of MRMDs, a newer understanding of the neurobiology of MRMDs, and newer treatment approaches. Likewise, historical perspectives and cultural views will be considered. We accept original research articles, systematic reviews, metanalysis, case series as well as concept papers.
The relationship of MRMDs with mood disorders (including bipolar disorders and major depression) has been studied extensively with conflicting findings. High rates of co-occurrence, premenstrual worsening of symptoms of mood disorders being diagnosed as MRMD, as well as the significant impact of MRMD on the severity, course, and treatment response have been reported. MRMD and Bipolar disorder II (more common in women) have been consistently reported to co-occur more often than Bipolar I. On the other hand, the link with other disorders remains virtually unexplored. With advances in research, understanding the neurobiology of MRMDs has made some progress. Genetic susceptibility, the role of neurosteroids, HPA axis abnormalities, and structural and functional differences in the brain have been put forth as some of the contributors to MRMD. The role of trauma has also been reported in many studies, however, it is not specific to MRMDs but is applicable to other psychiatric disorders.
Newer treatment approaches in MRMDs have also been parallelly developed with an improved understanding of the neurobiology of MRMD. Selective serotonin reuptake inhibitors are considered the first line of pharmacological interventions. Evidence for other antidepressant drugs like Serotonin Norepinephrine reuptake inhibitors, Mirtazapine is still lacking. The role of estrogen, progesterone, and its derivatives has been researched with results indicating their efficacy in MRMDs. Psychological treatments like Cognitive Behavior Therapy (CBT) have been extensively researched in the treatment of MRMD and the efficacy remains conflicting. Evidence for use of newer third wave therapies including mindfulness-based approaches is limited. Despite the modest effect of CBT, it is still considered as the first line of treatment more so for mild symptoms. Complementary and alternate medicine approaches for MRMD including yoga, herbal medicines, acupuncture have been studied but still, there is skepticism about their efficacy.
The diagnosis of PMDD has been criticized for lack of diagnostic validity, over pathologizing the normal physiological phenomenon, lack of cultural validation as well as criticism from feminist groups for subjectification of womens’ bodies. There is a need to conduct rigorous studies to establish diagnostic validity across different cultures with prospective ratings. Prospective studies on the course of PMDD and its diagnostic stability are necessary to understand this complex association, both from the biological and psychological points of view. The role of trauma has also been reported in many studies, however, it is not specific to MRMDs but is applicable to other psychiatric disorders. Would trauma-informed therapies have a potential role in the management of MRMDs? With advances in understanding neurobiology, how have the newer treatment approaches, including pharmacological, psychological, and complementary and alternate medicine approaches, have evolved?
This Research Topic aims to receive articles focusing on research on MRMDs. The focus of research may include diagnostic validity, course, and outcome of MRMDs, a newer understanding of the neurobiology of MRMDs, and newer treatment approaches. Likewise, historical perspectives and cultural views will be considered. We accept original research articles, systematic reviews, metanalysis, case series as well as concept papers.
Keywords: PMDD, MRMD, PMS, LLPDD
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