PubMed Health⌕ Search

Biomedical subjects

Ellen W Freeman

Publications and source records attributed to Ellen W Freeman.

25 records · Page 2Linked to original sources
PubMed2002

Citalopram in PMS patients with prior SSRI treatment failure: a preliminary study.

OBJECTIVES: Evidence shows that the selective serotonin reuptake inhibitors (SSRIs) effectively reduce the symptoms of severe premenstrual syndrome (PMS). A placebo-controlled study of citalopram, the most selective SSRI, demonstrated that half-cycle dosing (luteal phase) was effective for DSM-IV-defined premenstrual dysphoric disorder (PMDD), a severe form of PMS. This study examined the effectiveness of half-cycle dosing of citalopram in PMS patients who did not respond to previous SSRI treatment. METHODS: Seventeen women with no improvement in symptoms after two menstrual cycles on an SSRI were given open-label citalopram (20-40 mg/day). Eleven subjects received half-cycle dosing, and 6 subjects received full-cycle dosing. Scores on the 17-item daily symptom report (DSR) and on each of five DSR symptom clusters were used to measure citalopram efficacy. RESULTS: Total premenstrual DSR scores were significantly improved (p <0.001) in both half-cycle and full-cycle dosing groups. The half-cycle group reported lower DSR scores throughout treatment compared with the full-cycle group, but the difference did not reach statistical significance in this small sample. All DSR factor scores (mood, behavioral, pain, physical symptoms, and appetite) significantly improved. Clinical improvement (>or=50% decrease from baseline DSR) was reported by 76% of the subjects overall. Forty-one percent of the subjects experienced symptom remission, defined as a decrease in symptoms to postmenstrual levels. CONCLUSIONS: These results from a small number of subjects with open-label treatment must be viewed as preliminary but suggest that citalopram treatment is effective for PMS patients who failed previous SSRI treatment.

Adolescent↗
PubMed2002

Allopregnanolone levels and symptom improvement in severe premenstrual syndrome.

Allopregnanolone is a neuroactive metabolite of progesterone and a barbiturate-like modulator of central gamma-aminobutyric acid receptors that modify a range of behaviors, including the stress response. The aim of this study was to determine the association of allopregnanolone levels with improvement of mood and behavioral symptoms following antidepressant treatment for severe premenstrual syndrome. A second exploratory aim was to determine whether allopregnanolone levels differed between antidepressant and placebo treatments. Serum samples from 46 women who were treated with sertraline, desipramine, or placebo in double-blind conditions were assayed. Improvement was assessed as the percent change from the pretreatment baseline in premenstrual symptoms, which were rated daily by the subjects. Twenty-seven samples were from improved subjects and 19 samples were from unimproved subjects following 2 to 3 months of double-blind treatment. Posttreatment allopregnanolone levels were significantly lower in the improved compared with the unimproved subjects. Improvement was also significantly associated with lower allopregnanolone levels for premenstrual depression and appetite changes. Improvement remained significantly associated with lower allopregnanolone levels after adjustment for treatment, cycle day of blood draw, age, and the interaction of treatment and cycle day. These preliminary results offer the first placebo-controlled evidence of association between allopregnanolone levels and premenstrual syndrome treatment response and suggest the importance of further study of the associations of allopregnanolone with premenstrual syndromes and the role of allopregnanolone in response to antidepressant medications.

Adult↗
PubMedDate not supplied

Psychometric properties of a menopausal symptom list.

OBJECTIVE: To determine psychometric properties of a brief menopause symptom list and its sensitivity to menopausal status in a population-based cohort of late reproductive-age women. DESIGN: A 12-item menopause symptom list (MSL) administered in a cohort of African American and Caucasian women aged 38 to 52 years (N = 350) was psychometrically evaluated. Menopausal status of the cohort was determined by menstrual cycle dates obtained in interviews and participants' daily symptom records. Results of factor analysis were applied to longitudinal assessments of the cohort over a 3-year period. Convergent validity with other standard measures of mood, stress, health, and quality of life was determined. RESULTS: Internal consistency was found for the MSL items. Item total correlations are reported. Factor analysis identified three dimensions (psychological, somatic, and vasomotor). Multivariate analysis of cohort data over a 3-year interval showed that the menopausal symptoms increased over time (P = 0.0004) and that the identified factors were differentially associated with menopausal status. Psychological symptoms increased in the premenopausal and early transition groups but decreased in the late menopausal-postmenopausal groups (P = 0.0046 for the interaction). Vasomotor symptoms increased in both the early transition and late menopausal-postmenopausal groups (P = 0.0309 and P = 0.0543, respectively). Psychological symptoms (factor 1) had high correlations with other standard symptom measures (Center for Epidemiologic Studies-Depression Scale, r = 0.59; Zung Anxiety Scale, r = 0.65), whereas factors 2 and 3 did not, suggesting that the somatic and vasomotor symptoms were not associated with mood or health problems. CONCLUSIONS: The MSL provides a brief questionnaire with acceptable psychometric properties for assessing three dimensions of menopause-related symptoms and demonstrated sensitivity to menopausal status in a population-based cohort.

Adult↗
PubMedDate not supplied

Predictors of decreased libido in women during the late reproductive years.

OBJECTIVE: To identify risk factors for decreased libido among women in the late reproductive years. DESIGN: Prospective cohort. Women aged 35 to 47 years identified through random digit dialing were prospectively followed for 4 years with serial hormone assays and standardized questionnaires. Mean hormone values, hormone trends over 4 years, and fluctuation in hormone levels were compared among women with and without a decrease in libido at the last assessment period. Total testosterone, dihydroepiandrosterone sulfate, estradiol, follicle-stimulating hormone, luteinizing hormone, body mass index, psychosocial, and socioeconomic variables were evaluated using multivariable logistic regression. RESULTS: Of 326 women, 87 (27%) reported a decreased libido, whereas 239 (73%) did not. Participant-specific means for all hormone levels over the study period were similar among both groups. However, total testosterone fluctuation over the study was significantly different between groups. Women whose testosterone levels fluctuated from 3.8 to 21.5 ng/dL around a mean value of 9 ng/dL were four times more likely to report decreased libido compared with women with little fluctuation in testosterone [odds ratio (OR) 4.0; 95% CI, 1.6-10.0]. Depression (OR 3.4; 95%CI, 1.9-6.1), vaginal dryness (OR 3.5; 95%CI, 1.8-6.6), and children living at home (OR 1.4; 95%CI, 1.1-1.7) were also independently associated with decreased libido. CONCLUSIONS: Decreased libido in the late reproductive years is associated with a pronounced fluctuation in total testosterone over time. Other independent risk factors for decreased libido include vaginal dryness, depression, and living with children. Sexual dysfunction is a complex disorder, related to physiological and psychosocial factors, requiring further investigation.

Adult↗
PubMedDate not supplied

Predicting participation in prospective studies of ovarian aging.

OBJECTIVE: Identifying clinical markers and characteristics of the transition to menopause is an important woman's health issue, and recent long-term, prospective, cohort studies are just beginning to offer insight into methods of predicting the transition to menopause. One of the major challenges of conducting prospective cohort studies is the problem of attrition-both the retention of study participants and the influence of dropouts on the final study results. We conducted this systematic analysis to: 1) identify baseline predictors of subsequent long-term participation, and 2) determine the demographic, psychosocial, and hormonal differences between participants and dropouts among a group of premenopausal women enrolled in a longitudinal study of ovarian aging. DESIGN: Using data from the Penn Ovarian Aging study, premenopausal women aged 35 to 47 enrolled in the study were classified as either Active (full participants), Skipped, or Dropped participants based on their visit pattern during a 4-year study interval. RESULTS: Most of the demographic and psychosocial variables did not significantly differ between the Active, Skipped, or Dropped groups. There was no racial difference in study participation. The Dropouts were more likely to have a high school education and were less likely to report menopause symptoms compared with the Actives (P < 0.01). The Skipped group reported more anxiety (P < 0.05), and members were more likely to have less than a high school education compared with the Actives (P < 0.03). Hormone levels (estradiol, follicle-stimulating hormone, luteinizing hormone, dehydroepiandrosterone, testosterone) at enrollment were within the premenopausal range and did not significantly differ among the three study groups. These findings remained after adjustment for covariates and hormone levels in multivariate analyses. CONCLUSIONS: Education, anxiety levels and menopause symptoms at baseline differed marginally between the women participating fully and those who dropped out or skipped multiple assessments. These findings are important and indicate that long-term study participation rates do not differ substantially by racial group or any of the other demographic or hormonal characteristics examined.

Adult↗
PubMedDate not supplied

The role of anxiety and hormonal changes in menopausal hot flashes.

OBJECTIVE: To estimate the association of anxiety with menopausal hot flashes in the early transition to menopause. DESIGN: A randomly identified, population-based cohort of midlife women followed up for 6 years to assess reproductive hormones and other physical, emotional, and behavioral factors. At enrollment, the women were premenopausal, aged 35 to 47 years, and had regular menstrual cycles in the normal range. Enrollment was stratified to obtain equal numbers of African American (n = 219) and white (n = 217) women. RESULTS: At the 6-year endpoint, 32% of the women were in the early transition stage and 20% reached the late menopausal transition or were postmenopausal. Reports of hot flashes increased with the transition stages, which were determined by bleeding patterns. At endpoint, hot flashes were reported by 37% of the premenopausal women, 48% of those in the early transition, 63% of women in the late transition, and 79% of the postmenopausal women. Anxiety scores were significantly associated with the occurrence of hot flashes and were also significantly associated with the severity and frequency of hot flashes (each outcome at P < 0.001). Compared with women in the normal anxiety range, women with moderate anxiety were nearly three times more likely to report hot flashes and women with high anxiety were nearly five times more likely to report hot flashes. Anxiety remained strongly associated with hot flashes after adjusting for menopause stage, depressive symptoms, smoking, body mass index, estradiol, race, age, and time. In a predictive model, anxiety levels at the previous assessment period and the change in anxiety from the previous assessment period significantly predicted hot flashes (P < 0.001). CONCLUSIONS: Anxiety is strongly associated with menopausal hot flashes after adjusting for other variables including menopause stage, smoking, and estradiol levels. Anxiety preceded hot flashes in this cohort. Additional studies are needed to examine the duration of menopausal hot flashes and to determine whether treatments that target anxiety effectively reduce menopausal hot flashes.

Adult↗