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. 2017 Nov;136(5):473-482.
doi: 10.1111/acps.12797. Epub 2017 Aug 28.

Increased illness burden in women with comorbid bipolar and premenstrual dysphoric disorder: data from 1 099 women from STEP-BD study

A Slyepchenko  1   2 , B N Frey  1   2   3 , B Lafer  4 , A A Nierenberg  5   6 , G S Sachs  5   6 , R S Dias  4
Affiliations

Increased illness burden in women with comorbid bipolar and premenstrual dysphoric disorder: data from 1 099 women from STEP-BD study

A Slyepchenko et al. Acta Psychiatr Scand. 2017 Nov.

Abstract

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.

Trial registration: ClinicalTrials.gov NCT00012558.

Keywords: age of onset; bipolar disorder; burden of illness; menarche; premenstrual dysphoric disorder.

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Conflict of interest statement

Declaration of Interest

Dr. Lafer is supported by Brazilian Federal Research Grants and Scholarships from CNPq and CAPES and by a NARSAD Independent Investigator Award from the Brain & Behavior Research Foundation. Dr. Frey has received grant/research support from Alternative Funding Plan Innovations Award, Brain and Behavior Research Foundation, Canadian Institutes of Health Research, Hamilton Health Sciences Foundation, J.P. Bickell Foundation, Ontario Brain Institute, Ontario Mental Health Foundation, Society for Women’s Health Research, Teresa Cascioli Charitable Foundation, Eli Lilly, and Pfizer, and has received consultant and/or speaker fees from AstraZeneca, Bristol-Myers Squibb, Canadian Psychiatric Association, CANMAT, Daiichi Sankyo, Lundbeck, Pfizer, Servier and Sunovion. Dr. Sachs is a full-time employee of Bracket and a part-time employee of Massachusetts General Hospital; he has served on advisory boards for Allergan, Janssen, Intracellular Therapies, Lundbeck, Neuralstem, Otsuka, Pfizer, Sunovion, Supernus, and Takeda, and he is a shareholder in Amyris, ExpressScripts, and Oracle. Dr. Dias, Dr. Nierenberg and Ms. Slyepchenko report no competing interests. The study was registered at ClinicalTrials.gov on March 13, 2001: Identifier: NCT00012558.

Figures

Figure 1
Figure 1
Kaplan-Meier survival plots and log-rank test results of a) age of onset of bipolar disorder in women with and without premenstrual dysphoric disorder; b) gap between age menarche and onset of bipolar disorder in women with and without premenstrual dysphoric disorder. Abbreviations: PMDD = Premenstrual Dysphoric Disorder
Figure 2
Figure 2
Psychiatric comorbidities in women with and without premenstrual dysphoric disorder comorbid with bipolar disorder *** p<0.001, ** p<0.01, *p<0.05. Abbreviations: PMDD = Premenstrual Dysphoric Disorder.
See this image and copyright information in PMC

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