Increase in Serotonin Transporter Binding in Patients With Premenstrual Dysphoric Disorder Across the Menstrual Cycle: A Case-Control Longitudinal Neuroreceptor Ligand Positron Emission Tomography Imaging Study

Sacher, Julia; Zsido, Rachel G.; Barth, Cláudia; Zientek, Franziska; Rullmann, Michael; Luthardt, Julia; Patt, Marianne; Becker, Georg; Rusjan, Pablo; Witte, A. Veronica; Regenthal, Ralf; Koushik, Abhay; Kratzsch, Juergen; Decker, Beate; Jogschies, Petra; Villringer, Arno; Hesse, Swen; Sabri, Osama

doi:10.1016/j.biopsych.2022.12.023

Cited by 15 publications

(9 citation statements)

References 53 publications

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“…Studies have also found effects of sex hormones on serotonergic and GABAergic systems. In people with PMDD, who experience severe depressive symptoms in the luteal phase of the menstrual cycle, changes in serotonin receptors and transporters in the luteal phase are associated with reported adverse mood (Jovanovic et al, 2006;Sacher et al, 2023). This work supports the hypothesis that changes in the serotonergic system after OCs and GAHT could also affect mood.…”

Section: Neurotransmitter and Neurosteroid Changessupporting

confidence: 74%

Waves of Change: Sex Hormones, Depression and Sleep

Morssinkhof

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Depression is twice as common in women compared to men, and the risk of insomnia is 1.5 times higher in women than in men during the reproductive age. It has been suggested that sex hormones, including estrogen, testosterone and progesterone, may partly explain this difference in prevalence. Changes in these hormones may possibly contribute to more depressive symptoms and more insomnia. One way to examine the effects of sex hormones on depression and sleep is to investigate situations where individuals start taking exogenous hormonal medications. Therefore, this study aimed to examine the effects of oral contraceptives (OCs) and the effects of gender-affirming hormone therapy (GAHT). We examined whether the use of OCs and GAHT affected depressive symptoms, sleep quality, sleep architecture and chronotype. The main research questions in this thesis were: 1. Are OC use and GAHT use associated with changes in depression? 2. Are OC use and GAHT use associated with changes in sleep? 3. What are the effects of sex hormones on the association between depression and sleep? 1. Sex hormones and depression Our findings show that OC use could be associated with increases in depressive symptoms and increased risk of depression, but that there might be strong individual differences in the effects of OCs on mood. Our findings in transgender people who start GAHT suggest that masculinizing and feminizing sex hormones have different effects on depressive symptoms, although it must be noted that we find only small to modest changes. 2. Sex hormones and sleep We find that use of OCs could possibly have very small effects on sleep, and that this could be related to the day-night rhythm of the hormone cortisol. In our studies on GAHT, we see that transgender people on masculinizing GAHT show no clinically significant changes in insomnia or sleep quality, but they show shorter slow wave (deep) sleep and slightly longer and earlier REM (dream) sleep after starting GAHT, as well as a later chronotype. After starting feminizing GAHT, transgender people show a shorter subjective sleep onset latency, no changes in sleep architecture and an earlier chronotype. 3. Sex hormones, depression and sleep Results from our systematic review and our studies on OCs and GAHT do not provide substantive support for the hypothesis that sex hormones affect the relationship between depression and sleep. The research results in this thesis show that changes in sex hormones can lead to small changes in depressive symptoms that are in line with prevalence differences in the population: feminizing hormones, including OAC and GAHT, can lead to modest increases in depressive symptoms and masculinizing GAHT can lead to modest decreases in depression symptoms. The effects of sex hormones on subjective sleep vary, and GAHT was found to have strongest effects on sleep architecture and chronotype. The hypothesis that sex hormones cause poor sleep, which would then lead to increases in depressive symptoms, was not supported by our findings. For future studies on mood, I emphasize the importance of examining short-term changes in mood, since changes in daily moods and mood variability have been described after sex hormone changes. For future studies on sleep, I recommend to further study the role of previous and current sex hormone status (i.e., OC use, menopause status) on sleep architecture and chronotype. Lastly, I advocate for the inclusion of sex and sex hormones in psychiatric research and in clinical practice, to provide knowledge and techniques for prevention, early detection and treatment of sex hormone-related problems in sleep and mood.

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Section: Neurotransmitter and Neurosteroid Changessupporting

confidence: 74%

Waves of Change: Sex Hormones, Depression and Sleep

Morssinkhof

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“…Furthermore, increased serotonin transporter correlated with increased depressive symptoms. This indicates that the key may be the change in extracellular serotonin levels itself ( 52 ).…”

Section: Etiopathogenesismentioning

confidence: 99%

Premenstrual syndrome: new insights into etiology and review of treatment methods

Modzelewski,

Oracz,

Żukow

et al. 2024

Front. Psychiatry

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Premenstrual syndrome (PMS) is a common disorder affecting women of reproductive age, with an estimated global prevalence of 47.8%, with severe symptoms occurring in 3-8%, significantly affecting daily functioning. GABA conductance and changes in neurosteroid levels, particularly allopregnanolone, are suspected to play a substantial role in the disorder’s etiology. In this paper, we provide an overview of recent reports on the etiology and recognized therapeutic approaches, encompassing both pharmacological and non-pharmacological interventions. Our examination includes studies on SSRIs, hormonal agents, neurosteroids, supplementation, and therapeutic roles. We aim to determine the most favorable treatment regimen by comparing medication effects and alternative methods. The treatment of PMS is crucial for enhancing the quality of life for affected women. Medications used in PMS treatment should be individually selected to achieve the best therapeutic effect, considering the clinical situation of the patients.

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“…It has been revealed that low levels of estrogen during the early luteal phase are associated with worse psychological outcomes [40]. In general, individuals with PMDD are more sensitive to hormonal changes due to a decrease in the expression of serotonin transporters before the menstrual cycle, as observed in positron emission tomography imaging [41].…”

Section: Pms and Pmddmentioning

confidence: 99%

Reproductive Hormones and Female Mental Wellbeing

Wieczorek,

Targonskaya,

Maslowski

2023

Women

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Fluctuating hormone levels during the menstrual cycle and major reproductive cycle stages have been linked to mood changes, mental health conditions, and an increased likelihood of psychotic episodes. This knowledge could potentially be used for the predictive modeling of exacerbations and mood deterioration through the collection and analysis of data from wearables and apps. A literature search for a narrative review has been conducted using selected keywords in Pubmed, Embase and Google Scholar. Based on published data, it can be seen that hormonal changes affect the severity of symptoms in several mental health conditions, including depression, PMDD, PTSD, bipolar disorder and schizophrenia. The influence of FSH, LH, testosterone, and other hormone precursors has also been investigated, but there is less information available regarding their impact. E2 levels have been measured as a treatment–response biomarker and have demonstrated significant predictive ability for treatment responder groups. On the other hand, FSH has been demonstrated to be helpful in predicting treatment non-responder groups in schizophrenia. Monitoring reproductive hormones in combination with wearables or digital solutions has the potential to predict mood changes more effectively. Precise and frequent hormone measurements might prove to be more effective than relying on absolute threshold levels. Further research is needed to validate the utility and precision of hormone use in the field of mental health.

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Increase in Serotonin Transporter Binding in Patients With Premenstrual Dysphoric Disorder Across the Menstrual Cycle: A Case-Control Longitudinal Neuroreceptor Ligand Positron Emission Tomography Imaging Study

Cited by 15 publications

References 53 publications

Waves of Change: Sex Hormones, Depression and Sleep

Waves of Change: Sex Hormones, Depression and Sleep

Premenstrual syndrome: new insights into etiology and review of treatment methods

Reproductive Hormones and Female Mental Wellbeing

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