Increased illness burden in women with comorbid bipolar and premenstrual dysphoric disorder: data from 1 099 women from STEP‐BD study
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Background: The impact of comorbid premenstrual dysphoric disorder (PMDD) in women with bipolar disorder (BD) is largely unknown. Aims: We compared illness characteristics and female‐specific mental health problems between women with BD with and without PMDD. Materials & Methods: A total of 1 099 women with BD who participated in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP‐BD) were studied. Psychiatric diagnoses and illness characteristics were assessed using the Mini International Neuropsychiatric Interview. Female‐specific mental health was assessed using a self‐report questionnaire developed for STEP‐BD. PMDD diagnosis was based on DSM‐5 criteria. Results: Women with comorbid BD and PMDD had an earlier onset of bipolar illness (P < 0.001) and higher rates of rapid cycling (P = 0.039), and increased number of past‐year hypo/manic (P = 0.003), and lifetime/past‐year depressive episodes (P < 0.05). Comorbid PMDD was also associated with higher proportion of panic disorder, post‐traumatic stress disorder, generalized anxiety disorder, bulimia nervosa, substance abuse, and adult attention deficit disorder (all P < 0.05). There was a closer gap between BD onset and age of menarche in women with comorbid PMDD (P = 0.003). Women with comorbid PMDD reported more severe mood symptoms during the perinatal period and while taking oral contraceptives (P < 0.001). Discussion: The results from this study is consistent with research suggesting that sensitivity to endogenous hormones may impact the onset and the clinical course of BD. Conclusions: The comorbidity between PMDD and BD is associated with worse clinical outcomes and increased illness burden.
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In that study, there was a closer gap between BD onset and age of menarche in women with comorbid PMDD.
“In this study, there was a closer gap between BD onset and age of menarche in women with comorbid PMDD, which suggests that sensitivity to endogenous hormones may influence the onset and the clinical course of BD.”
In one of the largest studies (n = 1099), women who met DSM-5 provisional criteria for PMDD had an earlier illness onset, more comorbid Axis I disorders, a higher number of hypomanic/manic and depressive episodes, and higher rates of rapid cycling.
“One of the largest studies (n = 1099) found that women who met DSM‐5 provisional criteria for premenstrual dysphoric disorder (PMDD) had an earlier illness onset, more comorbid Axis I disorders, a higher number of hypomanic/manic and depressive episodes, and higher rates of rapid cycling.546”
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Cites
(1998) · The Journal of Clinical Psychiatry · Cited by 19,139 · see citing works
(1998) · PubMed · Cited by 10,216 · see citing works
The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication
Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007) · Biological Psychiatry · doi:10.1016/j.biopsych.2006.03.040 · Cited by 4,973 · see citing works
Prevalence, incidence and stability of premenstrual dysphoric disorder in the community
WITTCHEN, H.-U., BECKER, E., LIEB, R., & KRAUSE, P. (2002) · Psychological Medicine · doi:10.1017/s0033291701004925 · Cited by 554 · see citing works
Sachs, G. S., Thase, M. E., Otto, M. W., Bauer, M. S., Miklowitz, D. J., Wisniewski, S. R., Lavori, P. W., Lebowitz, B. D., Rudorfer, M., Frank, E., et al. (2003) · Biological Psychiatry · doi:10.1016/s0006-3223(03)00165-3 · Cited by 532 · see citing works
Self-citationThe Impact of Reproductive Events on the Course of Bipolar Disorder in Women
Freeman, M. P., Smith, K. W., Freeman, S. A., McElroy, S. L., Kmetz, G. F., Wright, R., & Keck, P. E. (2002) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v63n0403 · Cited by 286 · see citing works
Gender differences in bipolar disorder
Arnold, L. M. (2003) · Psychiatric Clinics of North America · doi:10.1016/s0193-953x(03)00036-4 · Cited by 272 · see citing works
Postpartum Psychosis: Madness, Mania, and Melancholia in Motherhood
Bergink, V., Rasgon, N., & Wisner, K. L. (2016) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2016.16040454 · Cited by 242 · see citing works
Gender differences in bipolar disorder: age of onset, course, comorbidity, and symptom presentation
Kawa, I., Carter, J. D., Joyce, P. R., Doughty, C. J., Frampton, C. M., Wells, J. E., Walsh, A. E. S., & Olds, R. J. (2005) · Bipolar Disorders · doi:10.1111/j.1399-5618.2004.00180.x · Cited by 231 · see citing works
Prevalence and predictors of premenstrual dysphoric disorder (PMDD) in older premenopausal women
Cohen, L. S., Soares, C. N., Otto, M. W., Sweeney, B. H., Liberman, R. F., & Harlow, B. L. (2002) · Journal of Affective Disorders · doi:10.1016/s0165-0327(01)00458-x · Cited by 209 · see citing works
Reproductive cycle-associated mood symptoms in women with major depression and bipolar disorder
Payne, J. L., Roy, P. S., Murphy-Eberenz, K. P., Weismann, M. M., Swartz, K., McInnis, M. G., Nwulia, E., Mondimore, F. M., MacKinnon, D. F., Miller, E. B., et al. (2006) · Journal of Affective Disorders · doi:10.1016/j.jad.2006.08.013 · Cited by 145 · see citing works
A clinical monitoring form for mood disorders
Sachs, G. S., Guille, C., & McMurrich, S. L. (2002) · Bipolar Disorders · doi:10.1034/j.1399-5618.2002.01195.x · Cited by 142 · see citing works
Self-citationRapid Cycling in Women and Men With Bipolar Manic-Depressive Disorders
Tondo, L., & Baldessarini, R. J. (1998) · American Journal of Psychiatry · doi:10.1176/ajp.155.10.1434 · Cited by 130 · see citing works
Kogan, J. N., Otto, M. W., Bauer, M. S., Dennehy, E. B., Miklowitz, D. J., Zhang, H., Ketter, T. A., Rudorfer, M. V., Wisniewski, S. R., Thase, M. E., et al. (2004) · Bipolar Disorders · doi:10.1111/j.1399-5618.2004.00158.x · Cited by 121 · see citing works
Self-citationStrategies for improving treatment of bipolar disorder: integration of measurement and management
Sachs, G. S. (2004) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2004.00409.x · Cited by 119 · see citing works
Self-citationRisk of Psychiatric Disorders Following Symptomatic Menopausal Transition
Hu, L., Shen, C., Hung, J., Chen, P., Wen, C., Chiang, Y.-Y., & Lu, T. (2016) · Medicine · doi:10.1097/md.0000000000002800 · Cited by 86 · see citing works
Prevalence and correlates of DSM-5 eating disorders in patients with bipolar disorder
McElroy, S. L., Crow, S. J., Blom, T. J., Biernacka, J. M., Winham, S. J., Geske, J. R., Barboza, A. B. C., Bobo, W. V., Prieto, M. L., Veldić, M., et al. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.11.010 · Cited by 80 · see citing works
Frey, B. N., & Dias, R. D. S. (2013) · Bipolar Disorders · doi:10.1111/bdi.12151 · Cited by 76 · see citing works
Self-citationDias, R. S., Lafer, B., Russo, C., Del Debbio, A., Nierenberg, A. A., Sachs, G. S., & Joffe, H. (2011) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2010.09121816 · Cited by 70 · see citing works
Self-citationLife events and onset of a new phase in bipolar affective disorder
Christensen, E. M., Gjerris, A., Larsen, J. K., Bendsen, B. B., Larsen, B. H., Rolff, H., Ring, G., & Schaumburg, E. (2003) · Bipolar Disorders · doi:10.1034/j.1399-5618.2003.00049.x · Cited by 64 · see citing works
Comparison of Lifetime Psychiatric Diagnoses in Premenstrual Syndrome Clinic and Community Samples
Stout, A. L., Steege, J. F., Blazer, D. G., & George, L. K. (1986) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-198609000-00002 · Cited by 57 · see citing works
Cirillo, P. C., Passos, R. B. F., Bevilaqua, M. C. D. N., López, J. R. R. A., & Nardi, A. E. (2012) · Brazilian Journal of Psychiatry · doi:10.1016/j.rbp.2012.04.010 · Cited by 54 · see citing works
Yen, J., Chang, S., Long, C., Tang, T., Chen, C., & Yen, C. (2011) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2011.05.016 · Cited by 51 · see citing works
Erol, A., Winham, S. J., McElroy, S. L., Frye, M. A., Prieto, M. L., Barboza, A. B. C., Fuentes, M. E., Geske, J. R., Mori, N. N., Biernacka, J. M., et al. (2015) · Bipolar Disorders · doi:10.1111/bdi.12329 · Cited by 46 · see citing works
Premenstrual tension syndrome in rapid-cycling bipolar affective disorder.
Price, W. A., & Dimarzio, L. R. (1986) · PubMed · Cited by 46 · see citing works
Clinical characteristics of women with reproductive cycle–associated bipolar disorder symptoms
Perich, T., Roberts, G. M. P., Frankland, A., Sinbandhit, C., Meade, T., Austin, M., & Mitchell, P. B. (2016) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867416670015 · Cited by 41 · see citing works
The impact of premenstrual dysphoric disorder among 92 bipolar patients
Fornaro, M., & Perugi, G. (2010) · European Psychiatry · doi:10.1016/j.eurpsy.2009.11.010 · Cited by 37 · see citing works
Robertson Blackmore, E., Craddock, N., Walters, J., & Jones, I. (2008) · Archives of Women's Mental Health · doi:10.1007/s00737-008-0215-2 · Cited by 34 · see citing works
Nobles, C. J., Thomas, J. J., Valentine, S. E., Gerber, M. W., Vaewsorn, A. S., & Marques, L. M. (2016) · International Journal of Eating Disorders · doi:10.1002/eat.22539 · Cited by 33 · see citing works
Comorbid bipolar disorder and premenstrual dysphoric disorder: real patients, unanswered questions
Frey, B. N., & Minuzzi, L. (2013) · Archives of Women's Mental Health · doi:10.1007/s00737-012-0313-z · Cited by 22 · see citing works
Self-citationPayne, J. L., Klein, S. R., Zamoiski, R. B., Zandi, P. P., Bienvenu, O. J., MacKinnon, D. F., Mondimore, F. M., Schweizer, B. W., Swartz, K., Crowe, R., et al. (2009) · Archives of Women s Mental Health · doi:10.1007/s00737-008-0043-4 · Cited by 17 · see citing works
Treating comorbid premenstrual dysphoric disorder in women with bipolar disorder
Smith, M., & Frey, B. N. (2016) · Journal of Psychiatry and Neuroscience · doi:10.1503/jpn.150073 · Cited by 17 · see citing works
Self-citationAffective temperaments in pregnancy
Yazıcı, E., Terzi, H., Boşgelmez, Ş., Yazıcı, A. B., Zincir, S. B., & Kale, A. (2014) · Gynecological Endocrinology · doi:10.3109/09513590.2014.943722 · Cited by 14 · see citing works
Illicit drug use, early age at first use and risk of premenstrual syndrome: A longitudinal study
Ju, H., Jones, M., & Mishra, G. D. (2015) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2015.03.037 · Cited by 9 · see citing works
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Self-citationHormonal Contraceptives and Mood: Review of the Literature and Implications for Future Research
Robakis, T., Williams, K. E., Nutkiewicz, L., & Rasgon, N. L. (2019) · Current Psychiatry Reports · doi:10.1007/s11920-019-1034-z · Cited by 103 · see citing works
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Dorani, F., Bijlenga, D., Beekman, A. T. F., van Someren, E. J. W., & Kooij, J. J. S. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2020.12.005 · Cited by 86 · see citing works
- Authors
- Slyepchenko, A., Frey, B. N., Lafer, B., Nierenberg, A. A., Sachs, G. S., & Dias, R. S.
- Affiliations
- St. Joseph’s Healthcare Hamilton (CA)
- Universidade de São Paulo (BR)
- Harvard University (US)
- Bipolar Disorder Research Program Department of Psychiatry University of São Paulo Medical School Sao Paulo Brazil
- Corresponding author
- Frey, B. N.
- Venue
- Acta Psychiatrica Scandinavica
- Publisher
- Wiley
- Published
- 2017-08-28
- Volume
- 136
- Issue
- 5
- Pages
- 473-482
- ISSN
- 0001-690X (ISSN-L)
- 1600-0447
- PMC
- PMC5630503
- OpenAlex
- W2748752460
- Cited by
- 49
- References
- 34
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 3 · 2023: 2 · 2022: 8 · 2021: 5 · 2020: 10 · 2019: 5 · 2018: 6
- FWCI
- 4.72
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Acta Psychiatrica Scandinavica (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, other-oa)
- Funders
- National Institutes of Health (N01MH80001)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Menstrual Health and Disorders
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Keywords
- bipolar disorder, premenstrual dysphoric disorder, comorbidities, women, disease burden, rapid cycling, depressive episodes, panic disorder, post-traumatic stress disorder, generalized anxiety disorder, bulimia nervosa, substance abuse, attention deficit disorder, age at menarche, oral contraceptives, hormone sensitivity, STEP-BD
- MeSH terms
- Adolescent, Adult, Bipolar Disorder, Female, Humans, Middle Aged, Comorbidity, Cost of Illness, Young Adult, Premenstrual Dysphoric Disorder
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