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Review
. 2023 Jun:149:105168.
doi: 10.1016/j.neubiorev.2023.105168. Epub 2023 Apr 12.

Towards understanding the biology of premenstrual dysphoric disorder: From genes to GABA

Liisa Hantsoo  1 , Jennifer L Payne  2
Affiliations
Review

Towards understanding the biology of premenstrual dysphoric disorder: From genes to GABA

Liisa Hantsoo et al. Neurosci Biobehav Rev. 2023 Jun.

Abstract

Premenstrual dysphoric disorder (PMDD) is a severe mood disorder, with affective symptoms that rise and fall in concert with the hormonal fluctuations of the menstrual cycle. PMDD's pathophysiology is poorly understood. This review describes recent research on potential biological contributors to PMDD, with a focus on neuroactive steroids, genetics, neuroimaging and cellular studies. Studies suggest that a key contributor is abnormal central nervous system (CNS) response to fluctuations in neuroactive steroid hormones. Imaging studies are limited but support alterations in serotonergic and GABA transmission. Genetic studies suggest heritability, yet specific genetic contributors have not been characterized. Finally, recent cutting-edge cellular studies indicate an underlying vulnerability to the effect of sex hormones at a cellular level. Overall the findings across studies do not yet fit together into a complete description of the underlying biology of PMDD. It is possible that PMDD consists of biological subtypes, and future research may benefit from a subtyping approach.

Keywords: Allopregnanolone; Depressive disorder; Menstrual cycle; Neuroactive steroid; Reproductive psychiatry.

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