Prior depression, PMDD, and pain: biological mechanisms

The purpose of this study was to examine the extent to which premenstrual dysphoric disorder (PMDD) and major depressive disorder (MDD), two depressive disorders unique or more common to women, exhibit distinct alterations in stress-responsive measures and experimental pain sensitivity. A total of 38 women completed all aspects of testing. Of these women, 17 met strict Diagnostic and Statistical Manual of Mental Disorders criteria for PMDD and were compared with 21 non-PMDD women for PMDD-related differences. For analyses regarding the influence of MDD on dependent measures, a history of MDD was used to model clinical MDD. In our sample, 13 women had a history of MDD and 25 women were classified as never depressed. All women were tested for pain sensitivity to cold pressor and tourniquet ischemic tasks, sympathetic nervous system (SNS) (blood pressure, heart rate, norepinephrine) and hypothalamic pituitary adrenal (HPA)-axis (cortisol and β-endorphin) functioning at baseline, and SNS responses to mental stress tasks. PMDD women displayed decreased threshold and tolerance to the cold pressor task (i.e. greater pain sensitivity), and blunted SNS reactivity to speech stress when compared to non-PMDD women. In addition, while Non-PMDD women showed a more consistent relationship between higher BP levels and decreased pain sensitivity, PMDD women showed a more robust relationship between greater β-endorphin levels and decreased pain sensitivity. Women with prior MDD showed persistent biological disturbances beyond the remission of the depressive episode, reflected in increased cold pressor tolerance (i.e. decreased pain sensitivity), increased premenstrual mood symptoms, greater diastolic blood pressure (BP) responsivity to stress, and an enhanced relationship between BP and pain than never depressed women. Finally, no diagnosis-related differences were found for any baseline HPA-axis factor. These results indicate that dysregulation in pain mechanisms and SNS stress reactivity, as well as in the relationship between pain and stress-related factors in PMDD and prior MDD, may be underlying physiological mechanisms contributing to the etiology of both disorders

Histories of depression, allopregnanolone responses to stress, and premenstrual symptoms in women

Twenty-six women with premenstrual dysphoric disorder (PMDD) and 39 non-PMDD women were tested for allopregnanolone (ALLO) responses to mental stress. Fourteen PMDD and 17 non-PMDD women had a history of depression (DEP), though all were free of current psychiatric illness. Women with prior DEP showed a blunted ALLO stress response and failed to show a decrease from venipuncture to baseline compared to women with no prior DEP. Women with prior DEP did not show the correlation between progesterone and ALLO that was seen in those with no prior DEP. ALLO levels at baseline and blunted ALLO reactivity predicted more severe premenstrual symptoms, but only in PMDD women with prior DEP. These results suggest that prior DEP is associated with a failure of ALLO to be appropriately responsive to challenge, with alterations in the conversion of progesterone to ALLO, and link ALLO to symptoms in PMDD women with prior DEP

Menstrual cycle phase does not influence gender differences in experimental pain sensitivity

Influence of menstrual cycle phase on experimental pain sensitivity in women and on gender differences in pain sensitivity was examined in 48 men and 49 women in response to cold pressor, heat, and ischemic pain. Each woman was tested at three points in their menstrual cycle in randomized order, the early follicular, late follicular, and luteal phases, while men were also tested three times, controlling for number of days between test sessions. Cycle phase was confirmed via serum hormone levels. As expected, women were significantly more sensitive to cold pain (p < .01), to heat pain (p < .0001), and to ischemic pain (p < .01) than men. However, pain perception during each task was not influenced by the menstrual cycle in women, nor did the menstrual cycle influence the magnitude of the gender differences in pain sensitivity. These results indicate that although women are more sensitive to a variety of noxious stimuli than men, menstrual cycle phase does not appear to moderate those differences in healthy men and women

Menstrual mood disorders are associated with blunted sympathetic reactivity to stress

AbstractObjectiveFew studies have directly compared women with a menstrually related mood disorder (MRMD) with women who have suffered from depression for stress reactivity phenotypes. It is unclear whether blunted responses to stress in women with a MRMD reflect a unique phenotype of MRMDs or may be explained by a history of depression.MethodsWe assessed cardiovascular reactivity to stress in four groups: 1) Women with a MRMD without a history of depression (n=37); 2) women with a MRMD plus a history of depression (n=26); 3) women without a MRMD and without a history of depression (n=43); and 4) women without a MRMD but with a history of depression (n=20).ResultsWomen with a MRMD showed blunted myocardial (heart rate and cardiac index) reactivity to mental stress compared to non-MRMD women, irrespective of histories of depression. Hypo-reactivity to stress predicted greater premenstrual symptom severity in the entire sample. Women with a MRMD showed blunted norepinephrine and diastolic blood pressure stress reactivity relative to women with no MRMD, but only when no history of depression was present. Both MRMD women and women with depression histories reported greater negative subjective responses to stress relative to their non-MRMD and never depressed counterparts.ConclusionOur findings support the assertion that a blunted stress reactivity profile represents a unique phenotype of MRMDs and also underscore the importance of psychiatric histories to stress reactivity. Furthermore, our results emphasize the clinical relevance of myocardial hypo-reactivity to stress, since it predicts heightened premenstrual symptom severity

Race and Histories of Mood Disorders Modulate Experimental Pain Tolerance in Women

Thirty-two African American and 23 non-Hispanic White women were compared for experimental pain threshold and tolerance to thermal, ischemic, and cold pressor pain. Approximately half of each group had prior mood disorders (17 African Americans, 13 non-Hispanic Whites), though all were free of current mood disturbance. Women with prior mood disorders were less sensitive to ischemic pain than women with no prior mood disorders (p<.05), while African Americans were more sensitive to ischemic pain than non-Hispanic Whites, though only at pain tolerance (p<.001). For cold pressor pain, the effects of race were only seen in women with prior mood disorders, since African Americans with prior mood disorders were more sensitive than non-Hispanic Whites with prior mood disorders (p<.05). These results indicate that experimental pain sensitivity in women is influenced by both race and histories of mood disorders

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

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

Central Processing of Noxious Somatic Stimuli in Patients With Irritable Bowel Syndrome Compared With Healthy Controls

To compare a central analgesic mechanism known as diffuse noxious inhibitory controls (DNIC) using somatic test stimuli and somatic conditioning stimuli, (CS) in irritable bowel syndrome (IBS) patients and healthy controls

Menstrual mood disorders are associated with blunted sympathetic reactivity to stress

Teacher assessment and evaluation (TAE) of a nation is an important determinant of its teacher quality and student achievement. However, the literature lacks a scale for displaying English teachers’ attitudes towards TAE model in an English as a Foreign Language (EFL) context where teachers are assessed and evaluated via high-stakes tests based on multiple choice questions. The English Teachers’ Attitudes towards Recruitment System Scale (ETARS) has been developed based on the existing literature, and data were collected from various stakeholders (policymakers, education experts, teacher trainers, teachers, student teachers). The data were piloted with 319 teachers through exploratory factor analysis. Then, a confirmatory factor analysis was utilized with 260 teachers. Results indicated the ETARS, comprised of 23 items and three dimensions, to be a valid and reliable instrument. Finally, the ETARS was applied to 260 English teachers to reveal their attitudes towards Turkish TAE model in terms of various variables. Findings displayed that English teachers had negative attitudes towards the current TAE model. This research fills the gap in the literature by providing the ETARS

Recalled and momentary virtual portions created of snacks predict actual intake under laboratory stress condition

Virtual portion tasks have been used to predict food intake in healthy individuals, severity of illness in individuals with anorexia nervosa, and weight loss in bariatric surgery patients. Whether portion creation in response to a recalled interpersonal stress (“recalled stress portions”) could be used as a proxy for ad lib intake, after a stressor, remains untested, and the mechanism supporting this relationship is unclear. The present study’s goals were: 1) to validate virtual portion tasks as proxies for actual food intake in a stressful context and 2) to test a causal pathway in which these virtual stress portions predict ad lib intake after stress. We proposed that this relationship is mediated by virtual portions created the moment after laboratory stress or rest manipulation (momentary portions), and before the participant actually ate food. At screening, 29 healthy undergraduate white women created virtual portions of eight snacks (apples, olives, potato chips, pretzels, caramel popcorn, milk chocolate) that they typically eat and also portions they recall eating in response to a stressful interpersonal situation. In addition, after a Trier Social Stress Test, or a rest period, on separate days in counterbalanced order, participants created ‘momentary’ virtual portions of the same snacks presented during screening, and then were given potato chips, mini golden Oreos, and M&Ms to eat. Recalled stress (b = 0.07 ± 0.02, p = 0.003), and momentary stress (b = 0.12 ± 0.02, p = 0.00001), portions of milk chocolate accounted for 29% and 51%, respectively, of the variance in ad lib stress intake of M&Ms. Typical (b = 0.15 ± 0.07, p = 0.03), and momentary rest (b = 0.21 ± 0.06, p = 0.002), portions of chips accounted for 16% and 31%, respectively, of the variance in ad lib rest intake of chips. The causal pathway from recalled stress portion to ad lib stress snack intake was completely mediated by momentary stress portion for milk chocolate and M&Ms (β = 0.04 ± 0.02, z = 2.4, p = 0.0154). These findings illustrate the planning and recall components of eating in response to stress, but not necessarily under rest conditions. This recalled stress virtual portion paradigm has clinical and research value in that it can detect those who overconsume in response to stress