Adverse effects of induced hot flashes on objectively recorded and subjectively reported sleep: results of a gonadotropin-releasing hormone agonist experimental protocol.

Objective: The impact of hot flashes on sleep is of great clinical interest, but results are inconsistent, especially when both hot flashes and sleep are measured objectively. Using objective and subjective measurements, we examined the impact of hot flashes on sleep by inducing hot flashes with a gonadotropin-releasing hormone agonist.

Methods: The gonadotropin-releasing hormone agonist leuprolide was administered to 20 healthy premenopausal volunteers without hot flashes or sleep disturbances.

Metabolic activity in the insular cortex and hypothalamus predicts hot flashes: an FDG-PET study.

Context: Hot flashes are a common side effect of adjuvant endocrine therapies (AET; leuprolide, tamoxifen, aromatase inhibitors) that reduce quality of life and treatment adherence in breast cancer patients. Because hot flashes affect only some women, preexisting neurobiological traits might predispose to their development. Previous studies have implicated the insula during the perception of hot flashes and the hypothalamus in thermoregulatory dysfunction.

Lifetime history of depression and anxiety disorders as a predictor of quality of life in midlife women in the absence of current illness episodes.

Context: It is unknown whether a history of depression, anxiety disorders, or comorbid depression and anxiety affects subsequent health-related quality of life (HRQOL) during midlife in women when vasomotor symptoms (VMS) and sleep disturbance commonly disrupt QOL.

Objectives: To evaluate whether previous affective illness is associated with low HRQOL during midlife in the absence of current illness episodes and whether low HRQOL is explained by VMS or sleep disruption.

Design: Longitudinal, community-based study.

Effect of medroxyprogesterone on depressive symptoms in depressed and nondepressed perimenopausal and postmenopausal women after discontinuation of transdermal estradiol therapy.

Objective: Concern about adverse effects of progestins on mood has influenced the use of medroxyprogesterone (MPA) and other progestins. In this brief report, we examined whether the administration of MPA leads to depressive symptoms in two groups of perimenopausal and postmenopausal women randomly assigned to treatment with estrogen: one currently experiencing clinical depression and another without depression.

Methods: Open-label MPA 10 mg/day was administered for 14 days for endometrial protection after completion of double-blinded treatment with 17β-estradiol 0.

Increased estradiol and improved sleep, but not hot flashes, predict enhanced mood during the menopausal transition.

Background: The antidepressant effect of estrogen in women undergoing the menopause transition is hypothesized to be mediated by central nervous system effects of increasing estradiol on mood or through a pathway involving suppression of hot flashes and associated sleep disturbance. Estrogen therapy (ET) and the hypnotic agent zolpidem were selected as interventions in a three-arm, double-blind, placebo-controlled trial to distinguish the effects of estradiol, sleep, and hot flashes on depression.

Methods: Women with depressive disorders, hot flashes, and sleep disturbance were randomly assigned to transdermal 17β-estradiol 0.

Evaluation and management of sleep disturbance during the menopause transition.

Sleep disturbances in midlife women are common and have been associated with the menopause transition itself, symptoms of hot flashes, anxiety and depressive disorders, aging, primary sleep disorders (i.e., obstructive sleep apnea, periodic limb movement disorder), comorbid medical conditions and medications, as well as with psychosocial and behavioral factors.

Complementary and alternative medicine in major depressive disorder: the American Psychiatric Association Task Force report.

Objective: To review selected complementary and alternative medicine (CAM) treatments for major depressive disorder (MDD).

Participants: Authors of this report were invited participants in the American Psychiatric Association's Task Force on Complementary and Alternative Medicine.

Evidence: The group reviewed the literature on individual CAM treatments for MDD, methodological considerations, and future directions for CAM in psychiatry.

Omega-3 fatty acids in major depressive disorder.

Patients with major depressive disorder have high rates of cardiovascular disease and other medical comorbidity. Omega-3 fatty acids, particularly those found in fish and seafood, have cardiovascular health benefits and may play an adjunctive role in the treatment of mood disorders. However, existing studies on omega-3 fatty acids in depression have limitations such as small sample sizes and a wide variance in study design, and results regarding efficacy are mixed.

Complementary and Alternative Medicine (CAM): considerations for the treatment of major depressive disorder.

The use of complementary and alternative medicine (CAM) has increased among patients with psychiatric disorders, as it has in the general population, over recent decades. Psychiatrists, therefore, need to inquire about and discuss the use of these treatments with patients and offer up-to-date information about risks and benefits. However, evidence-based information is limited.

Postpartum depression treatment and breastfeeding.

Postpartum depression occurs in about 10% to 20% of childbearing women. When developing a treatment plan, clinicians need to balance the risks of untreated maternal depression, the benefits of breastfeeding, and the risks associated with infant exposure to medication in breast milk. Data on the short-term safety and long-term consequences of antidepressant use during breastfeeding are meager, but several commonly used antidepressants appear to transfer at low levels into breast milk and may or may not be detectable in infant serum.

Managing depression during pregnancy.

During the reproductive years, depression is common in women, and many face treatment decisions during pregnancy. Possible risks of untreated maternal depression include increased risk of relapse and postpartum depression, all the serious risks associated with the untreated disorder in nonpregnant women, and obstetrical complications. Data on teratogenic risks of antidepressant use are inconsistent, but these risks should be taken into consideration.

Effect of reproductive hormones and selective estrogen receptor modulators on mood during menopause.

Periods of intense hormonal fluctuations have been associated with heightened prevalence and exacerbation of underlying psychiatric illness, particularly the occurrence of premenstrual dysphoria, puerperal depression and depressive symptoms during perimenopause. It has been speculated that sex steroids such as estrogens, progestogens, testosterone and dehydroepiandrosterone (DHEA) exert a significant modulation of brain functioning, possibly through interactions with various neurotransmitter systems. It is therefore intuitive that abrupt alterations of these hormones would interfere with mood and behaviour.

Hormone treatment for mood disorders in women.

Periods of intense hormonal fluctuations have been associated with heightened prevalence and exacerbation of underlying psychiatric illness, particularly the occurrence of premenstrual dysphoria, puerperal depression and depressive symptoms during the menopausal transition. It has been speculated that sex steroids, such as estrogens, progestogens, testosterone and dehydroepiandrosterone, exert a significant modulation of brain functioning, possibly through interactions with various neurotransmitter systems. It is therefore intuitive that abrupt alterations of these hormones would interfere with mood and behavior.

Obstetrical and neonatal outcome following clonazepam use during pregnancy: a case series.

Background: Given the high prevalence of panic disorder in women, treatment decisions are frequently made regarding the use of anti-panic medications during the childbearing years and during pregnancy. The objective of this case series was to evaluate obstetric and neonatal outcome associated with treatment with clonazepam during pregnancy.

Methods: Subjects were 38 women with histories of panic disorder who used clonazepam during pregnancy.

The perimenopause, depressive disorders, and hormonal variability.

Context: Several investigations have postulated that the perimenopause may represent a period of increased psychiatric vulnerability, particularly for mood disorders. This review characterizes the perimenopause, including biological changes, the influence of psychosocial factors and the most common clinical manifestations. Clinic-based studies and community-based surveys addressing the prevalence of depressive symptoms in perimenopausal women are critically reviewed.