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Association between Premenstrual Dysphoric Disorder and Systemic Lupus Erythematosus: Exacerbation of Major Depression Symptoms?

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DOI: 10.4236/ojra.2013.34032    3,338 Downloads   5,759 Views   Citations


Introduction: Systemic Lupus Erythematosus (SLE) usually presents neuropsychiatric manifestations, such as psychosis, convulsion, mood disorder and chronic headache, with mood disorder being the most prevalent. It is also known that other psychiatric disorders and menstrual cycle disorders are frequent in SLE. The aim of this study was to describe for the first time the frequency of premenstrual dysphoric disorder in patients with SLE diagnosis, and its association with depression and anxiety. Material and Methods: An evaluation was made of 62 (sixty-two) patients with diagnosis of SLE, based on the American College of Rheumatology criteria, who received follow-up care at an ambulatory reference center. The patients were submitted to a sociodemographic evaluation questionnaire, upon which the Mini International Neuropsychiatric Interview (MINI PLUS), Brazilian Version 5.0.0, was used to evaluate the diagnosis. Results: Twenty (32%) patients were found to have premenstrual dysphoric disorder, and there was a statistically significant association with major depression (p = 0.010), but no statistical significance was found with dysthymia (p = 0.063) or anxiety (p = 0.223). Conclusions: The frequency of premenstrual dysphoric disorder (PMDD) in patients with SLE was high, as well as the frequency of major depression in this group. There was an association between these two disorders.

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The authors declare no conflicts of interest.

Cite this paper

S. Cal, L. Alonso, A. Almeida, M. Santiago and Â. Miranda-Scippa, "Association between Premenstrual Dysphoric Disorder and Systemic Lupus Erythematosus: Exacerbation of Major Depression Symptoms?," Open Journal of Rheumatology and Autoimmune Diseases, Vol. 3 No. 4, 2013, pp. 209-215. doi: 10.4236/ojra.2013.34032.


[1] J. F. Ampelas, M. J. Wattiaux and A. P. Van Amerongen, “Psychiatric Manifestations of Lupus Erythematosus Systemic and Sjogren’s Syndrome,” Encephale, Vol. 27, No. 6, 2001, pp. 588-599.
[2] J. G. Hanly, G. McCurdy, L. Fougere, J. A. Douglas and K. Thompson, “Neuropsychiatric Events in Systemic Lupus Erythematosus: Attribution and Clinical Significance,” Journal of Rheumatology, Vol. 31, No. 11, 2004, pp. 2156-2162.
[3] E. C. Miguel, R. M. Pereira, C. A. Pereira, L. Baer, R. E. Gomes, L. C. de Sa, et al., “Psychiatric Manifestations of Systemic Lupus Erythematosus: Clinical Features, Symptoms, and Signs of Central Nervous System Activity in 43 Patients,” Medicine (Baltimore), Vol. 73, No. 4, 1994, pp. 224-232.
[4] F. G. Nery, E. F. Borba, J. P. Hatch, J. C. Soares, E. Bonfa and F. L. Neto, “Major Depressive Disorder and Disease Activity in Systemic Lupus Erythematosus,” Comprehensive Psychiatry, Vol. 48, No. 1, 2007, pp. 14-19.
[5] ACR Ad Hoc Committee on Neuropsychiatric Lupus Nomenclature, “The American College of Rheumatology Nomenclature and Care Definitions for Neuropsychiatric Lupus Syndromes,” Arthritis & Rheumatism, Vol. 42, No. 4, 1999, pp. 599-608.
[6] F. G. Nery, E. F. Borba, V. S. Viana, J. P. Hatch, J. C. Soares, E. Bonfa, et al., “Prevalence of Depressive and Anxiety Disorders in Systemic Lupus Erythematosus and Their Association with Anti-Ribosomal P Antibodies,” Progress in Neuro-Psychopharmacology & Biological Psychiatry, Vol. 32, No. 3, 2008, pp. 695-700.
[7] N. N. Fatnoon, S. M. Azarisman and D. Zainal, “Prevalence and Risk Factors for Menstrual Disorders among Systemic Lupus Erythematosus Patients,” Singapore Medical Journal, Vol. 49, No. 5, 2008, pp. 413-418.
[8] B. B. Dean, J. E. Borenstein, K. Knight and K. Yonkers, “Evaluating the Criteria Used for Identification of PMS,” Journal of Women’s Health (Larchmt), Vol. 15, No. 5, 2006, pp. 546-555.
[9] U. Halbreich, J. Borenstein, T. Pearlstein and L. S. Kahn, “The Prevalence, Impairment, Impact, and Burden of Premenstrual Dysphoric Disorder (PMS/PMDD),” Psycho- neuroendocrinology, Vol. 28, No. S3, 2003, pp. 1-23.
[10] J. F. Mortola, “Premenstrual Syndrome,” Trends in Endocrinology & Metabolism, Vol. 7, No. 5, 1996, pp. 184-189.
[11] G. C. Valadares, L. Ferreira, H. Correa Filho and M. Romano-Silva, “Transtorno Disfórico Pré-Menstrual Revi- sao: Conceito, História, Epidemiologia e Etiologia,” Revista de Psiquiatria Clínica, Vol. 33, 2006, pp. 117-123.
[12] K. Yonkers, P. M. O’Brien and E. Ericksson, “Premenstrual Syndrome,” The Lancet, Vol. 371, No. 9619, 2008, pp. 1200-1210.
[13] S. Girdler and R. Klatzkin, “Neurosteroid in the Context of Stress: Implications for Depressive Disorders,” Pharmacology & Therapeutics, Vol. 116, No. 1, 2007, pp. 125-139.
[14] H. Ainiala, J. Loukkola, J. Peltola, M. Korpela and A. Hietaharju, “The Prevalence of Neuropsychiatric Syndromes in Systemic Lupus Erythematosus,” Neurology, Vol. 57, No. 3, 2001, pp. 496-500.
[15] E. A. Bachen, M. A. Chesney and L. A. Criswell, “Prevalence of Mood and Anxiety Disorders in Women with Systemic Lupus Erythematosus,” Arthritis & Rheumatism, Vol. 61, No. 6, 2009, pp. 822-829.
[16] U. Halbreich and J. Endicott, “Relationship of Dysphoric Premenstrual Changes to Depressive Disorders,” Acta Psychiatrica Scandinavica, Vol. 71, No. 4, 1985, pp. 331-338.
[17] M. N. Miller and B. E. Miller, “Premenstrual Exacerbations of Mood Disorders,” Psychopharmacological Bulletin, Vol. 35, No. 3, 2001, pp. 135-149.
[18] L. A. Futterman and A. J. Rapkin, “Diagnosis of Premenstrual Disorders,” The Journal of Reproductive Medicine, Vol. 51, No. 4, 2006, pp. 349-358.
[19] J. W. Bailey and L. S. Cohen, “Prevalence of Mood and Anxiety Disorders in Women Who Seek Treatment for Premenstrual Syndrome,” Journal of Women’s Health & Gender-Based Medicine, Vol. 8, No. 9, 1999, pp. 1181-1184.
[20] J. Endicott, “The Menstrual Cycle and Mood Disorders,” Journal of Affective Disorders, Vol. 29, No. 2-3, 1993, pp. 193-200.
[21] M. Pires and H. Calil, “Associacao Entre Transtorno Disfórico Pré-Menstrual e Transtornos Depressivos,” Revista Brasileira de Psiquiatria, Vol. 21, 1999, pp. 118-127.
[22] D. G. Ayache and I. Costa, “Alteracoes da Personalidade no Lúpus Eritematoso Sistêmico,” The Brazilian Journal of Rheumatology, Vol. 45, No. 5, 2005, pp. 313-318.
[23] M. Alpay and E. H. Cassem, “Diagnosis and Treatment of Mood Disorders in Patients with Rheumatic Disease,” Annals of the Rheumatic Diseases, Vol. 59, No. 1, 2000, pp. 2-4.
[24] D. P. Chapman, G. S. Perry and T. W. Strine, “The Vital Link between Chronic Disease and Depressive Disorders,” Preventing Chronic Disease, Vol. 2, No. 1, 2005, p. A14.
[25] E. M. Tan, A. S. Cohen, J. F. Fries, A. T. Masi, D. J. Mc-Shane, N. F. Rothfield, et al., “The 1982 Revised Criteria for the Classification of Systemic Lupus Erythematosus,” rthritis & Rheumatism, Vol. 25, No. 11, 1982, pp. 1271-1277.
[26] P. Amorim, “Mini International Neuropsychiatric Interview (MINI): Validacao de Entrevista Breve para Diagnóstico de Transtornos Mentais/Mini International Neuropsychiatric Interview (MINI): Validation of a Short Structured Diagnostic Psychiatric Interview,” The Revista Bra- sileira de Psiquiatria, Vol. 22, No. 3, 2000, pp. 106-115.
[27] U. Halbreich, “The Etiology, Biology, and Evolving Pathology of Premenstrual Syndromes,” Psychoneuroendocrinology, Vol. 28, No. S3, 2003, pp. 55-99.
[28] I. Rodrigues and E. Oliveira, “Prevalência e Convivência de Mulheres com Síndrome Pré-Menstrual,” Arquivos de Ciências da Saúde, Vol. 13, No. 3, 2006, pp. 146-152.
[29] S. F. Cal, A. P. Borges and M. B. Santiago, “Prevalência e classificacao da Depressao em Pacientes com Lúpus Eritematoso Sistêmico Atendidos em um Servico de Referência da Cidade de Salvador,” Jornal da LIRRNE, Vol. 2, 2006, pp. 36-43.
[30] J. Bancroft, D. Rennie and P. Warner, “Vulnerability to Perimenstrual Mood Change: The Relevance of a Past History of Depressive Disorder,” Psychosomatic Medicine, Vol. 56, No. 3, 1994, pp. 225-231.
[31] C. M. Nogueira and J. Pinto, “Prevalência dos Sintomas da Síndrome Pré-Menstrual,” Revista Brasileira de Ginecologia e Obstetricia, Vol. 22, 2000, pp. 347-351.
[32] T. B. Pearlstein, “Hormones and Depression: What Are the Facts about Premenstrual Syndrome, Menopause, and Hormone Replacement Therapy?” American Journal of Obstetrics & Gynecology, Vol. 173, No. 2, 1995, pp. 646-653.
[33] S. A. Hartlage, K. E. Arduino and S. Gehlert, “Premenstrual Dysphoric Disorder and Risk for Major Depressive Disorder: A Preliminary Study,” Journal of Clinical Psychology, Vol. 57, No. 12, 2001, pp. 1571-1578.
[34] F. Akdeniz and F. Karadag, “Does Menstrual Cycle Affect Mood Disorders?” Türk Psikiyatri Dergisi, Vol. 17, No. 4, 2006, pp. 296-304.
[35] P. K. Braverman, “Premenstrual Syndrome and Premenstrual Dysphoric Disorder,” Journal of Pediatric & Adolescent Gynecology, Vol. 20, No. 1, 2007, pp. 3-12.
[36] L. Plouffe Jr., K. Stewart, K. S. Craft, M. S. Maddox and J. L. Rausch, “Diagnostic and Treatment Results from a Southeastern Academic Center-Based Premenstrual Syndrome Clinic: The First Year,” American Journal of Obstetrics Gynecology, Vol. 169, No. 2, Pt. 1, 1993, pp. 295-303.
[37] T. B. Pearlstein, U. Halbreich, E. D. Batzar, C. S. Brown, J. Endicott, E. Frank, et al., “Psychosocial Functioning in Women with Premenstrual Dysphoric Disorder before and after Treatment with Sertraline or Placebo,” The Journal of Clinical Psychiatry, Vol. 61, No. 2, 2000, pp. 101-109.
[38] A. D’Mello, L. Pinheiro and M. Lalined-Michaud, “Pre-Menstrual Mania: Two Case Report,” The Journal of Nervous and Mental Disease, Vol. 181, No. 5, 1993, pp. 330-331.
[39] D. Conrad and A. H. Hamilton, “Recurrent Premenstrual Declive in Serum Lithium Concentration: Clinical Correlates and Treatment Implications,” Journal of the American Academy of Child Psychiatry, Vol. 25, No. 6, 1986, 852-853.
[40] M. Cutolo, S. Capellino, A. Sulli, B. Serioli, M. E. Secchi, B. Villaggio and R. H. Straub, “Estrogens and autoimmune diseases,” Annals of New York Academy of Sciences, Vol. 1089, 2006, pp. 538-547.
[41] D. Moreira and J. Mello Filho, “Psicoimunologia Hoje,” In: Artmed Ed., Psicossomática Hoje, Porto Alegre, 1992, pp. 119-151.
[42] S. O. Nunes, E. M. Reich, H. K. Morimoto, E. N. Itano, E. C. Xavier, C. M. Yamoshita, et al., “Immune and Hormonal Activity in Adults Suffering from Depression,” Brazilian Journal of Medical and Biological Research, Vol. 35, No. 5, 2002, pp. 581-587.
[43] A. Rapkin, “A Review of Treatment of Premenstrual Syndrome and Premenstrual Dysphoric Disorder,” Psychoneuroendcrinology, Vol. 28, Suppl. 3, 2003, pp. 39-53.
[44] R. Glick, W. Harrison, J. Endicott, P. McGrath and F. M. Quitkin, “Treatment of Premenstrual Dysphoric Symptoms in Depressed Women,” Journal of American Medical Women’s Association, Vol. 46, No. 6, 1991, pp. 182-185.
[45] N. Navarrete-Navarrete, M. I. Peralta-Ramírez, J. M. Sabio, I. Martínez-Egea, A. Santos-Ruiz and J. Jiménez-Alonso, “Quality-of-Life Predictor Factors in Patients with SLE and Their Modification after Cognitive Behavioural Therapy,” Lupus, Vol. 19, No. 14, 2010, pp. 1632-1639.

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