Prior depression, PMDD, and pain: Biological mechanisms.

摘要

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 beta-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 beta-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.