Luteal-phase accentuation of acoustic startle response in women with premenstrual dysphoric disorder

Abstract

Alterations in central nervous system response to menstrual cycle-related fluctuations in neuroactive steroids are thought to underlie the emergence of negative affect in the luteal phase of the menstrual cycle in women with premenstrual dysphoric disorder (PMDD). Such changes in the neuroendocrine milieu may lead to heightened arousal and response to stress in women with PMDD. Using the acoustic startle paradigm, we sought to determine whether women with PMDD have an accentuated physiologic response to a mildly aversive stimulus during the luteal compared to follicular phase. Further, we also examined the impact of visual affective stimuli on acoustic startle response (ASR) magnitude. During the follicular and luteal phases of the menstrual cycle, acoustic stimuli (103 dB) were delivered to 15 women with PMDD and 14 healthy menstruating women of similar age. After obtaining baseline ASR, the procedure was repeated when subjects viewed pleasant, neutral and unpleasant pictures. There was a significant group by menstrual cycle phase interaction for baseline ASR magnitude, which can be attributed to the heightened startle magnitude in women with PMDD compared to healthy women during the luteal relative to the follicular phase. The direction and degree to which picture viewing modulated the startle magnitude did not vary by group or menstrual cycle phase. These data suggest that menstrual cycle phase has a powerful modulatory effect on physiologic reactivity in women with PMDD but not in healthy women. Physiologic response to affective stimuli appears to be intact in women with PMDD across the menstrual cycle.

Figure 1

Luteal-phase baseline startle is accentuated in women with PMDD. Women with PMDD experienced a significant increase in baseline ASR magnitude from follicular to luteal phase (F_{1, 18.8}=10.2, adjusted p=0.01).

Figure 2

Affective modulation of startle. ASR–stimulation–group–phase. Results of mixed models analyses of affective modulation of the ASR revealed a significant phase (F_{1, 18.9}=7.76, adjusted p=0.02); group–phase (F_{1, 18.2}=9.10, adjusted p=0.02); and stimulation (F_{2, 88}=17.6, adjusted p=0.0001). However, ASR response to stimulation did not vary by group or phase alone.