Genetic Cause Found Likely for Premenstrual Dysphoric Disorder

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Scientists from Rockefeller University have identified a gene that they say is likely to have a strong involvement in premenstrual dysphoric disorder (PMDD) and other menstrual cycle concerns that affects five to ten percent of American women.

The researchers studied the genes of female mice and found that a change in one amino acid on a gene called brain-derived neurotrophic factor (BDNF) which works with estrogen to enhance the adaptability of neurons in the hippocampus portion of the brain. This genetic variation is carried by 20-30% of Caucasian women and increases anxiety, dampens curiosity, and plays a key role in mood, cognition and memory.

The mice with the variant, called BDNF Met, performed less well on memory tasks, particularly at a high-estrogen stage of the estrous cycle, and appeared skittish, spending less time exploring objects placed in their cage.

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Past research has shown that BDNF Met is a risk factor for psychiatric problems such as depression and bipolar disorder, and is generally associated with impaired memory and anxiety.

Most women have a variety of physical and emotional symptoms related to their menstrual cycles, sometimes called premenstrual syndrome or PMS, however some women have a more severe form known as premenstrual dysphoric disorder. PMDD significantly interferes with a woman’s ability to function in her everyday life.

For a diagnosis of PMDD, a woman must experience four or more of the following symptoms:
• Mood swings
Depressed mood or feelings of hopelessness
• Significant feelings of anger
• Increased interpersonal conflicts
• Tension and anxiety
• Irritability
• Significantly decreased interest in usual activities
• Great difficulty concentrating
• Fatigue
• Change in appetite
• Feeling out of control or overwhelmed
Sleep problems, including sleeping too much, restless sleep, or inability to sleep
• Physical problems, such as bloating, headaches, joint or muscle pain

Women who have a family or personal history of depression or postpartum depression are at higher risk for developing PMDD.

There are a variety of treatments available to help reduce the severity of PMDD symptoms, including:
Optimal diet — Cutting out or reducing alcohol, caffeine and chocolate is important, as these ingredients may exacerbate symptoms. Limit salt and sugar during the second half of the menstrual cycle. Do not skip meals; if appetite is poor, try eating several small meals during the day. Complex carbohydrates, such as whole grains, may help increase serotonin in the brain which can help to improve mood.
Exercise -- Daily exercise can help to improve mood and ease anxiety symptoms.
Antidepressants – Medications like Celexa, Prozac, Zoloft, and Paxil make many women with more severe PMS and PMDD feel better. Your doctor will help you decide the course of therapy best for you.
Hormone therapy — Estrogen-containing birth control pills can help regulate menstrual cycles and often alleviate severe PMS symptoms. The American College of Obstetricians and Gynecologists (ACOG) recently issued a practice bulletin to help physicians better understand which pills are best for women with PMDD.
Psychotherapy — Psychotherapy can help a woman learn to better cope with the symptoms and with other challenges in her life. Therapy can also teach stress reduction techniques, meditation and relaxation — exercises that help many women better face the symptoms of PMDD.

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