Biomedical subjects

Andrea J Rapkin

Publications and source records attributed to Andrea J Rapkin.

15 recordsLinked to original sources

PubMed2006

Oral contraceptives and neuroactive steroids.

A deregulation in the peripheral and brain concentrations of neuroactive steroids has been found in certain pathological conditions characterized by emotional or affective disturbances, including major depression and anxiety disorders. In this article we summarize data pertaining to the modulatory effects of oral contraceptive treatment on neuroactive steroids in women and rats. Given that the neuroactive steroids concentrations are reduced by oral contraceptives, together with the evidence that a subset of women taking oral contraceptives experience negative mood symptoms, we propose the use of this pharmacological treatment as a putative model to study the role of neuroactive steroids in the etiopathology of mood disorders. Moreover, since neuroactive steroids are potent modulators of GABA(A) receptor function and plasticity, the treatment with oral contraceptives might also represent a useful experimental model to further investigate the physiological role of these steroids in the modulation of GABAergic transmission.

Affect↗

PubMed2006

Neurophysiologic changes during estrogen augmentation in perimenopausal depression.

BACKGROUND: Estrogen augmentation of antidepressant medication has been an effective treatment in a subgroup of women experiencing affective symptoms during perimenopause. It has been suggested that estrogen facilitates serotonergic transmission in brain regions involved in mood disorders. We investigated differences in physiologic brain changes with estrogen augmentation in women with perimenopausal depression who reached remission compared to those who did not reach remission. We also assessed whether such changes were correlated with serum hormone levels. METHODS: Quantitative electroencephalography (QEEG) was used to examine neurophysiologic brain changes in remission and non-remission of depressive symptoms. Women with major depressive disorder (MDD) in partial remission who were taking antidepressant medication for a minimum of 8 weeks and were experiencing two or more perimenopausal symptoms (hot flashes, night sweats, irregular periods, memory impairment, vaginal dryness) were recruited from the community. Absolute power, relative power, and QEEG cordance, a measure that has moderately strong associations with cerebral perfusion, were obtained before and after 6 weeks of treatment with 0.625 mg of conjugated estrogen per day. RESULTS: Women who experienced remission of depressive symptoms (Ham-D< or =7) had a significant decrease in right frontal QEEG cordance (p=0.008, t((8))=-3.54) which was not present in non-remitters. No significant correlations were found between hormone levels and QEEG cordance. CONCLUSION: In women with perimenopausal depression, physiologic brain changes in the right frontal region during estrogen augmentation were associated with remission of depression.

Administration, Oral↗

PubMed2006

Decreased neuroactive steroids induced by combined oral contraceptive pills are not associated with mood changes.

OBJECTIVE: To evaluate the effects of a low-dose combined oral contraceptive pill (OCP) on peripheral neuroactive steroid concentrations, precursors for neuroactive steroid synthesis, and mood in healthy women desiring contraception. These neuroactive steroids are gamma-aminobutyric acid receptor agonists and are important in the modulation of affect and adaptation to stress. DESIGN: Prospective observational study. SETTING: Human ambulatory patient study. PATIENT(S): Healthy OCP-naive women without current or history of affective disorder. INTERVENTION(S): A 0.020-mg ethinyl E2-0.1-mg levonorgestrel containing OCP for 3 months. MAIN OUTCOME MEASURE(S): Serum neuroactive steroids allopregnanolone, allotetrahydrodeoxycorticosterone, and DHEA; neuroactive steroid precursors P and pregnenolone; E2; and mood and anxiety as assessed by the Premenstrual Syndrome Daily Ratings Form, Beck Depression Inventory, Spielberger State-Trait Anxiety Inventory, and Profile of Mood States. RESULT(S): The combined OCP resulted in a decrease in neuroactive steroids and neuroactive steroid precursors as well as in E2. However, this decline was not associated with adverse mood changes on any of the well-validated assessment tools. CONCLUSION(S): Healthy women without underlying mood or anxiety disorder who were given a low-dose OCP did not experience adverse psychological symptoms despite a significant reduction in neuroactive steroids.

Adolescent↗

PubMed2006

Relationships among self-rated tanner staging, hormones, and psychosocial factors in healthy female adolescents.

STUDY OBJECTIVE: Females are more likely than males to suffer from various mood and pain disorders. However, this female predominance does not appear to develop until puberty. The purpose of the present study was to examine the associations among hormone concentrations, self-rated Tanner staging and dysmenorrhea, and to determine whether various psychosocial factors modulate these relationships. DESIGN: As part of a larger prospective study of the influence of puberty on laboratory pain response, Tanner ratings, estradiol and follicle stimulating hormone concentrations, dysmenorrhea and psychosocial parameters including depression, anxiety, somatization, and socioeconomic status were observed. PARTICIPANTS: 124 healthy girls ages 8 to 18 were evaluated. MAIN OUTCOME MEASURE: There were significant correlations between pubertal status utilizing self-rated diagrams of Tanner stage and hormonal markers of pubertal development, specifically estradiol and FSH. Tanner stage but not estradiol was correlated with presence of dysmenorrhea. There was no effect of body mass index (BMI), socioeconomic status (SES), anxiety, depression, or somatization on presence or absence of painful menses. There was no correlation between BMI or SES and age of menarche. However, Tanner stage was correlated with BMI but not with SES. RESULTS AND CONCLUSIONS: Tanner self-staging is at least as accurate as estradiol and FSH measurements alone in evaluating healthy female adolescents' physical changes and menstrual pain. Tanner self-ratings are thus particularly useful in large, epidemiologic, or cross cultural studies where physical examination and blood sampling may not be feasible due to cost, access, or psychosocial barriers.

Adolescent↗

PubMed2006

Premenstrual syndrome in adolescents: diagnosis and treatment.

It is estimated that 60-80% of menstruating women experience some degree of premenstrual symptomatology; however the diagnosis of premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) is assigned, using defined criteria, to those women whose lives are significantly affected by moderate to severe symptoms. Though these diagnoses are not frequently made in the adolescent group, the literature suggests that a similar proportion of teens would also meet criteria for PMS/PMDD. In adolescents, treatment should begin with education and lifestyle changes; however, many of the treatments used commonly in adults can also be employed safely in severe adolescent cases.

Adolescent↗

PubMed2006

Premenstrual disorders: prevalence, etiology and impact.

Millions of reproductive-age U.S. women experience premenstrual symptoms with varying degrees of severity. The large number and variety of premenstrual symptoms reported have made premenstrual disorders difficult to characterize. A number of mechanisms have been proposed to explain the etiology of premenstrual symptoms. Some women appear to have a genetic predisposition toward severe premenstrual symptoms or to have vulnerability traits that increase their risk. It has been suggested that 1 or more neurotransmitters and/or neurohormonal systems in certain women may have an abnormal response to normal fluctuations in gonadal hormones across the menstrual cycle. Premenstrual disorders can have a significant negative impact on a woman's quality of life and work productivity.

Female↗

PubMed2006

Diagnosis of premenstrual disorders.

Premenstrual disorders are characterized by numerous mood, somatic and behavioral symptoms that occur during the late luteal phase of a woman's menstrual cycle and abate soon after the onset of menses. Diagnostic criteria for premenstrual syndrome (PMS) were published by the American College of Obstetricians and Gynecologists in 2000; the American Psychiatric Association had previously established very specific diagnostic criteria for premenstrual dysphoric disorder (PMDD). Both diagnoses require 2 months of prospective symptom ratings, which can be accomplished using forms designed by individual clinicians or employing 1 of a number of validated instruments. The patient will need to provide a complete family and personal history of mental disorders and medical diseases. A thorough physical examination and certain basic laboratory tests should either identify or rule out many potential causes of the symptoms. The diseases, disorders or situations considered in the differential diagnosis of PMS and PMDD will depend on the woman's presenting symptoms. Many women with a bothersome or debilitating premenstrual disorder go undiagnosed, either because they do not report their symptoms to a clinician or because the clinician has difficulty diagnosing the disorder.

Diagnosis, Differential↗

PubMed2006

Treatment of premenstrual disorders.

Premenstrual disorders are characterized by a wide variety of affective and somatic symptoms. This diversity of presenting symptoms has led to the use of many different types of treatment approaches, none of which has proven to be successful in all women with these disorders. Non-pharmacologic options include aerobic exercise, dietary changes and supplementation, and cognitive-behavioral therapy. Of the pharmacologic agents used to treat premenstrual symptoms, 3 selective serotonin reuptake inhibitors have received a Food and Drug Administration (FDA) indication for treating premenstrual dysphoric disorder (PMDD). Agents that are often used off label to treat premenstrual symptoms include spironolactone and oral contraceptives (OCs); gonadotropin-releasing hormone (GnRH) agonists and alprazolam are used less frequently in these patients. OCs have historically had little consistent data from controlled clinical trials to support their efficacy until a number of recent studies showed that an OC containing the novel progestin drospirenone is effective in reducing premenstrual symptoms in many women. A new drospirenone-containing OC formulation that is administered for 24 days in a 28-day cycle has been shown to be effective in treating PMDD.

Alprazolam↗

PubMed2005

The pains of endometriosis.

Endometriosis is a disease defined by the presence of endometrial tissue outside of the uterus. Severe pelvic pain is often associated with endometriosis, and this pain can be diminished with therapies that suppress estrogen production. Many women with endometriosis also suffer from other chronic pain conditions. Recent studies suggest that mechanisms underlying these pains and sensitivity to estrogen involve the growth into the ectopic endometrial tissue of a nerve supply, which could have a varied and widespread influence on the activity of neurons throughout the central nervous system.

Animals↗

PubMed2005

Gynecological health of females with congenital heart disease.

Because of major advances in diagnostic and surgical methods, females with congenital heart disease (CHD) now survive into and beyond their reproductive years. Management of pregnancy in this patient population is well described, but gynecologic management such as menstruation, contraception and menopause have received scanty attention. Accordingly, the gynecologic health issues confronting these patients are described. Menstrual patterns in acyanotic females with CHD are similar to the general population, but cyanotic females have menstrual irregularities including amenorrhea, which implies anovulation and an increased risk of uterine carcinoma. Anticoagulants predispose to heavy vaginal bleeding and corpus luteum rupture. Contraceptives must be selected according to individual patient profiles. Hormone replacement therapy is warranted for relief of menopausal symptoms as in the general population and should be relatively safe because estrogen dose is low.

Abortion, Induced↗

PubMed2005

Estrogen augmentation of antidepressants in perimenopausal depression: a pilot study.

OBJECTIVE: To investigate the effects of estrogen augmentation on mood and memory in women with perimenopausal depression who had experienced a partial response to antidepressant medications. METHOD: In a double-blind, placebo-controlled trial, 17 subjects taking antidepressant medication were randomly assigned to either 0.625 mg/day of conjugated estrogen (N = 11) or matching placebo (N = 6) for 6 weeks. Women between the ages of 40 and 60 years with DSM-IV major depressive disorder (MDD) in partial remission who had been taking antidepressant medication for a minimum of 8 weeks and were experiencing 1 or more perimenopausal symptoms (hot flashes, night sweats, irregular periods, sleep disturbance, memory impairment) were recruited from the community. The primary outcome measures were the final scores for the Hamilton Rating Scale for Depression (HAM-D) and the Buschke Selective Reminding Test. Data were gathered from April 2002 to August 2003. RESULTS: Women receiving estrogen had a significantly larger decrease in HAM-D scores than women receiving placebo (t = 2.86, df = 15, p = .012). Group differences in tests of verbal memory were not significant, although improved scores in verbal memory were significantly correlated with a decrease in follicle-stimulating hormone (p = .021). CONCLUSION: Short-term, low-dose estrogen augmentation of antidepressant medication was significantly associated with improved mood, but not memory, in perimenopausal women with MDD in partial remission.

Adult↗

PubMed2005

New treatment approaches for premenstrual disorders.

Several approaches to alleviating the symptoms of premenstrual disorders are available to women and can be tailored according to individual needs and preferences. This article discusses methods that entail changes to lifestyle and diet and managing life stresses without relying on drug therapy, as well as a variety of medications that may be necessary in addition to or in place of recommended lifestyle modifications. New pharmacologic research is promising and is discussed along with the need to provide empathetic counseling for patients to determine the approach that will work best for each individual.

Counseling↗

PubMed2002

The clinical nature and formal diagnosis of premenstrual, postpartum, and perimenopausal affective disorders.

Various mood and anxiety disorders are more prevalent in reproductive-aged women, and appear to be linked to hormonal and reproductive events. Premenstrual affective disorders consist of premenstrual syndrome, premenstrual dysphoric disorder, and premenstrual exacerbation of mood or anxiety disorders. Postpartum affective disorders can range from postpartum "blues" to postpartum depression with or without psychosis, and also include anxiety disorders, such as panic disorder, generalized anxiety disorder, social phobia, and obsessive-compulsive disorder. In perimenopausal women, the vulnerability to mood and anxiety disorders is increased. All of these disorders share risk factors, and have etiologic features in common, such as exposure to the rise and fall of ovarian sex steroids. The following is a review of these syndromes and their etiology, diagnosis, and treatment.

Adult↗

PubMed2002

Estrogen replacement therapy in the treatment of major depressive disorder in perimenopausal women.

BACKGROUND: Increased vulnerability to mood disorders has been reported during perimenopause. Fluctuating estrogen levels accompany the perimenopausal transition. Thus, estrogen replacement therapy (ERT) has been proposed as a potentially effective treatment for mood disorders occurring during perimenopause. METHOD: We examined the efficacy of ERT in the treatment of depression in 16 perimenopausal women with DSM-IV-defined major depressive disorder who were participating in the Mood Disorders Research Program at the Department of Psychiatry of the University of California, Los Angeles. Ten antidepressant- and ERT-naive women received ERT alone. Six women who were nonresponders or partial responders to an antidepressant received ERT in addition to existing treatment with fluoxetine. The Hamilton Rating Scale for Depression (HAM-D) was administered to all patients at baseline and weekly thereafter during the 8-week open-protocol trial. Partial response was operationalized as a final HAM-D score < or = 50% of the baseline score. Remission was defined as a final HAM-D score < or = 7. RESULTS: All patients exhibited clinical improvement as measured by HAM-D scores after the first week of treatment. Of the 10 perimenopausal depressed women receiving ERT alone, 6 remitted, 3 partially responded to treatment, and 1 did not respond by the end of the trial. Of the 6 women receiving antidepressant treatment with ERT, 1 patient remitted and 5 had a partial response by the end of the trial. CONCLUSION: This small study suggests that for some antidepressant-naive perimenopausal women with clinical depression, ERT may have antidepressant efficacy. In depressed women who have minimal response to a selective serotonin reuptake inhibitor, ERT may augment response. Further controlled trials are needed.

Adult↗

PubMed1990

Effectiveness of an interdisciplinary pain management program for the treatment of chronic pelvic pain.

Chronic pelvic pain has rarely been discussed in the pain management literature, although it is extremely common in general gynecological practice and often refractory to traditional medical and surgical therapy. A chronic pelvic pain program was developed to offer an alternative treatment approach for women for whom standard gynecological procedures were inappropriate or unsuccessful. Sixteen subjects completed the full 6-8 week interdisciplinary program, which included both somatic and behavioral therapies. Compared to a waiting list control the results showed a dramatic decrease in reported levels of pain following treatment. Anxiety and depression also decreased and psychosocial functioning improved, including return to work, increased social activities, and improved sexual activity. The outcome suggests that the interdisciplinary pain management approach is effective for the treatment of chronic pelvic pain.

Adult↗