Late, but not early, wake therapy reduces morning plasma melatonin: Relationship to mood in Premenstrual Dysphoric Disorder

Abstract

Wake therapy improves mood in Premenstrual Dysphoric Disorder (PMDD), a depressive disorder in DSM-IV. We tested the hypothesis that the therapeutic effect of wake therapy in PMDD is mediated by altering sleep phase with melatonin secretion.We measured plasma melatonin every 30 minutes (18:00 -09:00 h) in 19 PMDD and 18 normal control (NC) women during mid follicular (MF) and late luteal (LL) menstrual cycle phases, and during LL interventions with early wake therapy (EWT) (sleep 03:00-07:00 h)(control condition) versus late wake therapy (LWT) (sleep 21:00-01:00 h)(active condition).Melatonin offset was delayed and duration was longer in the symptomatic LL vs. asymptomatic MF phase in both NC and PMDD subjects. LWT, but not EWT, advanced offset and shortened duration vs. the LL baseline, although they improved mood equally. Later baseline LL morning melatonin offset was associated with more depressed mood in PMDD patients, and longer melatonin duration in the MF phase predicted greater mood improvement following LWT.That LWT, but not EWT, advanced melatonin offset and shortened duration while they were equally effective in improving mood suggests that decreasing morning melatonin secretion is not necessary for the therapeutic effects of wake therapy in PMDD.

Pilot Investigation of the Circadian Plasma Melatonin Rhythm across the Menstrual Cycle in a Small Group of Women with Premenstrual Dysphoric Disorder

“…The endogenous melatonin rhythm is masked by postural changes [33] and light exposure [34], both of which were well-controlled for in this study. Reduced melatonin in PMDD vs. controls was initially reported [13], [14], but not in a recent study [35]. The reasons for this discrepancy are unclear, but the authors point out differences in radioimmunoassay kits, as well as methods of determining melatonin timing parameters that were assessed either quantitatively based on threshold values [13], [14] or qualitatively based on visual inspection [35].…”

ISPMD consensus on the management of premenstrual disorders

“…It is commonly considered that exercise improves premenstrual symptoms through elevation of beta-endorphin levels and improved well-being however there is no evidence to confirm this. Small RCTs have suggested efficacy of sleep deprivation and light therapy (Parry et al 2008, see review Shechter and Boivin 2010). These treatments are theorised to regulate circadian rhythms; however the duration of any therapeutic effects, if any, is unclear.…”

The Relationship of Nocturnal Melatonin to Estradiol and Progesterone in Depressed and Healthy Pregnant Women

“…This finding parallels our previous study of women with PMDD, in which increased melatonin duration was associated with depressive symptoms in the luteal phase, when P 4 is elevated, but not in the follicular phase, when P 4 is absent and women with PMDD are asymptomatic. 39 In a previous study of menopausal women, we also found that DLMOff was delayed in DW compared with HW. 18 Notably, delayed DLMOff is associated with an evening chronotype commonly found in depressive disorders.…”

“…For example, morning/late-night, but not evening/early-night, wake therapy advances melatonin offset in PMDD. 39 The strengths of this study include careful screening and diagnostic assessments of depression using objective, interview-based assessments by trained mental health professionals in women selected from a broad range of ages, parity, ethnicities, and socioeconomic status, with sampling distributed across the seasons of the year and precise circadian sampling of plasma melatonin. Study limitations include reliance on relatively small samples of women.…”