Histories of major depression and premenstrual dysphoric disorder: Evidence for phenotypic differences

Abstract

This study examined unique versus shared stress and pain-related phenotypes associated with premenstrual dysphoric disorder (PMDD) and prior major depressive disorder (MDD). Sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal (HPA)-axis measures were assessed at rest and during mental stress, as well as sensitivity to cold pressor and tourniquet ischemic pain tasks in four groups of women: (1) non-PMDD with no prior MDD (N=18); (2) non-PMDD with prior MDD (N=9); (3) PMDD with no prior MDD (N=17); (4) PMDD with prior MDD (N=10). PMDD women showed blunted SNS responses to stress compared to non-PMDD women, irrespective of prior MDD; while women with prior MDD showed exaggerated diastolic blood pressure responses to stress versus never depressed women, irrespective of PMDD. However, only in women with histories of MDD did PMDD women have lower cortisol concentrations than non-PMDD women, and only in non-PMDD women was MDD associated with reduced cold pressor pain sensitivity. These results suggest both unique phenotypic differences between women with PMDD and those with a history of MDD, but also indicate that histories of MDD may have special relevance for PMDD.

Figure 1

Mean (± SEM) Daily Mood Ratings Core Symptom Categories as a Function of PMDD and Prior MDD Status

Figure 2

Mean (± SEM) Cortisol as a Function of PMDD and Prior MDD Status

Figure 3

Mean (± SEM) Change in Sympathetic Nervous System Factors from Baseline to Speech Stress as a Function of PMDD and Prior MDD Status

Figure 4

Mean (± SEM) Change in Norepinephrine from Baseline to Speech Stress as a Function of PMDD and Prior MDD Status

Figure 5

Mean (± SEM) Cold Pressor Pain Threshold and Tolerance as a Function of PMDD and Prior MDD Status