Rationale

Women with premenstrual dysphoric disorder (PMDD) appear to have altered central nervous system sensitivity to neuroactive steroid hormones, manifesting as affective symptoms and heightened arousal in the luteal phase of the menstrual cycle. In particular, women with PMDD appear less sensitive to allopregnanolone, a positive allosteric GABA-A receptor (GABA-A-R) modulator.

Objectives

This study evaluated psychophysiologic reactivity in women with PMDD in the follicular and luteal phases of the menstrual cycle, utilizing anxiety-potentiated startle (APS), a potential translational marker of GABA-A-R sensitivity. The study also assessed APS response to low-dose sertraline treatment in women with PMDD.

Methods

Participants’ APS and fear-potentiated startle (FPS) were assessed in the follicular and luteal phases. Women with PMDD received 50 mg sertraline in the following luteal phase to examine impact on APS and FPS.

Results

There were no significant differences between controls (n = 41) and PMDD participants (n = 36) in change from follicular to luteal phases in baseline startle, APS nor FPS. However, among participants who responded to sertraline, APS was higher in the untreated luteal phase than the follicular phase, but lower in the treated luteal phase than the follicular phase.

Conclusion

These data demonstrate elevated psychophysiologic arousal in the luteal phase among some women with PMDD, suggesting impaired ability to modulate arousal reactivity. Specifically, alterations in APS suggest potential GABA-A-R changes across the menstrual cycle and in response to sertraline among treatment responders.

中文翻译：

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对舍曲林的反应与经前烦躁障碍中焦虑增强惊吓的减少有关

 基本原理

患有经前烦躁症 (PMDD) 的女性似乎改变了中枢神经系统对神经活性类固醇激素的敏感性，表现为情感症状和月经周期黄体期的觉醒加剧。特别是，患有经前抑郁症的女性似乎对别孕酮（一种正变构 GABA-A 受体 (GABA-AR) 调节剂）不太敏感。

 目标

本研究利用焦虑增强惊吓 (APS)（GABA-AR 敏感性的潜在转化标志物）评估了经前抑郁症 (PMDD) 女性在月经周期卵泡期和黄体期的心理生理反应。该研究还评估了患有经前抑郁症 (PMDD) 的女性对低剂量舍曲林治疗的 APS 反应。

 方法

在卵泡期和黄体期评估参与者的 APS 和恐惧增强惊吓 (FPS)。患有经前抑郁症 (PMDD) 的女性在随后的黄体期接受 50 毫克舍曲林，以检查对 APS 和 FPS 的影响。

 结果

对照组 ( n = 41) 和 PMDD 参与者 ( n = 36) 在基线惊吓、APS 和 FPS 方面从卵泡期到黄体期的变化没有显着差异。然而，在对舍曲林有反应的参与者中，未治疗的黄体期的 APS 高于卵泡期，但治疗的黄体期的 APS 低于卵泡期。

 结论

这些数据表明，一些患有经前抑郁症的女性在黄体期的心理生理唤醒程度较高，表明调节唤醒反应的能力受损。具体来说，APS 的变化表明 GABA-AR 在整个月经周期中以及治疗反应者对舍曲林的反应中可能发生变化。