Abstract
We investigated whether women diagnosed with comorbid bipolar disorder (BD) and premenstrual dysphoric disorder (PMDD) experience higher disruptions in biological rhythms in two independent study samples. The first study has a population-based sample of 727 women, including 104 women with PMDD only, 43 women with BD only, 24 women with comorbid PMDD and BD, and 556 women without BD or PMDD (controls). Biological rhythm disruptions were cross-sectionally evaluated using the Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN). The second study enrolled 77 outpatient women who completed prospective assessments at two timepoints: during the mid-follicular and the late-luteal phases of their menstrual cycles, using the BRIAN, and included 19 women with PMDD, 16 with BD, 17 with comorbid PMDD and BD, and 25 controls. In the population-based sample, all the diagnostic groups (BD, PMDD, BDPMDD) presented greater biological rhythm disruption than controls. In addition, women with BD presented greater overall biological rhythms disruption, and greater disruption in sleep, activity, and eating patterns, than women with PMDD. In the outpatient sample study, women with BDPMDD showed greater disruption in the social domain than women with PMDD. In the outpatient sample, women with BDPMDD reported significantly higher disruptions in biological rhythms across both the follicular and the luteal phases of the menstrual cycle. The comorbidity between BD and PMDD may affect biological rhythms beyond the luteal phase of the menstrual cycle. These results support previous literature on the increased illness burden of women diagnosed with comorbid BD and PMDD.
Similar content being viewed by others
References
Allega OR, Leng X, Vaccarino A, Skelly M, Lanzini M, Hidalgo MP, Soares CN, Kennedy SH, Frey BN (2018) Performance of the biological rhythms interview for assessment in neuropsychiatry: an item response theory and actigraphy analysis. J Affect Disord 225:54–63. https://doi.org/10.1016/j.jad.2017.07.047
Alloy LB, Nusslock R, Boland EM (2015) The development and course of bipolar spectrum disorders: an integrated reward and circadian rhythm dysregulation model. Annu Rev Clin Psychol 11(1):213–250. https://doi.org/10.1146/annurev-clinpsy-032814-112902
Amorim P (2000) Mini International Neuropsychiatric Interview (MINI): Validação de entrevista breve para diagnóstico de transtornos mentais. Rev Brasil Psiquiatr 22(3):106–115. https://doi.org/10.1590/S1516-44462000000300003
Arnold LM (2003) Gender differences in bipolar disorder. Psychiatr Clin N Am 26(3):595–620. https://doi.org/10.1016/S0193-953X(03)00036-4
Baker FC, Driver HS (2007) Circadian rhythms, sleep, and the menstrual cycle. Sleep Med 8(6):613–622. https://doi.org/10.1016/j.sleep.2006.09.011
Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ (1989) The pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res 28(2):193–213. https://doi.org/10.1016/0165-1781(89)90047-4
Dodd S, Katsenos S, Tiller J, Berk M (2005) Clinical characteristics and management of bipolar disorder in women across the life span. Women’s Health 1(3):421–428. https://doi.org/10.2217/17455057.1.3.421
Eidelman P, Talbot LS, Gruber J, Harvey AG (2010) Sleep, illness course, and concurrent symptoms in inter- episode bipolar disorder. J Behav Ther Exp Psych 41(2):145–149. https://doi.org/10.1016/j.jbtep.2009.11.007
Endicott J, Nee J, Harrison W (2006) Daily Record of Severity of Problems (DRSP): reliability and validity. Arch Women’s Ment Health 9(1):41–49. https://doi.org/10.1007/s00737-005-0103-y
Faria AD, de Azevedo CT, Campos Mondin T, de Mattos Souza LD, da Silva Magalhaes PV, Patrick Zeni C, da Silva RA, Kapczinski F, Jansen K (2015) Biological rhythms in bipolar and depressive disorders: a community study with drug-naïve young adults. J Affect Disord 186:145–148. https://doi.org/10.1016/j.jad.2015.07.004
First MB, Spitzer RL, Gibbon M, Williams JB (2002) Structured clinical interview for DSM-IV-TR axis i disorders, research version, patient edition with psychotic screen (SCID-I/P W/PSY SCREEN). Biometrics Research, New York State Psychiatric Institute, New York
Frey BN, Dias RS (2014) Sex hormones and biomarkers of neuroprotection and neurodegeneration: Implications for female reproductive events in bipolar disorder. Bipolar Disord 16(1):48–57. https://doi.org/10.1111/bdi.12151
Frey BN, Minuzzi L (2012) Comorbid bipolar disorder and premenstrual dysphoric disorder: real patients, unanswered questions. Arch Womens Ment Health 16:79–81
Giglio LMF, da Silva Magalhães PV, Andreazza AC, Walz JC, Jakobson L, Rucci P, Rosa AR, Hidalgo MP, Vieta E, Kapczinski F (2009) Development and use of a biological rhythm interview. J Affect Disord 118:161–165. https://doi.org/10.1016/j.jad.2009.01.018
Halbreich U, Borenstein J, Pearlstein T, Kahn LS (2003) The prevalence, impairment, impact, and burden of premenstrual dysphoric disorder (PMS/PMDD). Psychoneuroendocr 28:1–23. https://doi.org/10.1016/S0306-4530(03)00098-2
Hamilton M (1960) A rating scale for depression. J Neurol Neurosurg Psychiatry 23(1):56–62
Jackson A, Cavanagh J, Scott J (2003) A systematic review of manic and depressive prodromes. J Affect Disord 74(3):209–217. https://doi.org/10.1016/S0165-0327(02)00266-5
Jansen K, da Costa OL, de Azevedo CT, da Costa LR, de Mattos SL, da Silva Magalhães PV, Pinheiro RT, da Silva RA (2011) Prevalence of episodes of mania and hypomania and associated comorbidities among young adults. J Affect Disord 130(1–2):328–333. https://doi.org/10.1016/j.jad.2010.10.007
Judd LL, Schettler PJ, Akiskal HS, Coryell W, Leon AC, Maser JD, Solomon DA (2008) Residual symptom recovery from major affective episodes in bipolar disorders and rapid episode relapse/recurrence. Arch Gen Psych 65(4):386–394. https://doi.org/10.1001/archpsyc.65.4.386
Mangiafico SS (2016) Summary and analysis of extension program evaluation in R, version 1.18.1. https://rcompanion.org/handbook/F_08.html. Accessed June 2020
Miller JN, Black DW (2020) Bipolar disorder and suicide: a review. Curr Psych Rep 22(2):6. https://doi.org/10.1007/s11920-020-1130-0
Montgomery SA, Åsberg M (1979) A new depression scale designed to be sensitive to change. Br J Psych 134(4):382–389. https://doi.org/10.1192/bjp.134.4.382
Perich TA, Roberts G, Frankland A, Sinbandhit C, Meade T, Austin MP, Mitchell PB (2017) Clinical characteristics of women with reproductive cycle–associated bipolar disorder symptoms. Aust NZ J Psych 51(2):161–167. https://doi.org/10.1177/0004867416670015
Pinho M, Sehmbi M, Cudney LE, Kauer-Sant’anna M, Magalhães PV, Reinares M, Bonnín CM, Sassi RB, Kapczinski F, Colom F, Vieta E, Frey BN, Rosa AR (2016) The association between biological rhythms, depression, and functioning in bipolar disorder: a large multi-center study. Acta Psychiatr Scand 133(2):102–108. https://doi.org/10.1111/acps.12442
Rosa AR, Comes M, Torrent C, Solè B, Reinares M, Pachiarotti I, Salamero M, Kapczinski F, Colom F, Vieta E (2013) Biological rhythm disturbance in remitted bipolar patients. Int J Bipol Disord 1:6. https://doi.org/10.1186/2194-7511-1-6
Schmidt PJ, Nieman LK, Danaceau MA, Adams LF, Rubinow DR (1998) Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome. N Engl J Med 338(4):209–216
Schmidt PJ, Martinez PE, Nieman LK, Koziol DE, Thompson KD, Schenkel L, Wakim PG, Rubinow DR (2017) Premenstrual dysphoric disorder symptoms following ovarian suppression: triggered by change in ovarian steroid levels but not continuous stable levels. Am J Psychiatry 174(10):980–989
Slyepchenko A, Frey BN, Lafer B, Nierenberg AA, Sachs GS, Dias RS (2017) Increased illness burden in women with comorbid bipolar and premenstrual dysphoric disorder: Data from 1099 women from STEP-BD study. Acta Psychiatr Scand 136(5):473–482. https://doi.org/10.1111/acps.12797
Slyepchenko A, Minuzzi L, Frey BN (2021) Comorbid premenstrual dysphoric disorder and bipolar disorder: a review. Front Psychiatry 12:719241. https://doi.org/10.3389/fpsyt.2021.719241
Smith M, Frey BN (2016) Treating comorbid premenstrual dysphoric disorder in women with bipolar disorder. J Psych Neurosci 41(2):E22–E23
Syan SK, Minuzzi L, Smith M, Costescu D, Allega OR, Hall GB, Frey BN (2018) Brain structure and function in women with comorbid bipolar and premenstrual dysphoric disorder. Front Psych 8:301. https://doi.org/10.3389/fpsyt.2017.00301
Teatero ML, Mazmanian D, Sharma V (2014) Effects of the menstrual cycle on bipolar disorder. Bipol Disord 16(1):22–36. https://doi.org/10.1111/bdi.12138
Tondo L, Baldessarini RJ (1998) Rapid cycling in women and men with bipolar manic-depressive disorders. Am J Psych 155(10):1434–1436. https://doi.org/10.1176/ajp.155.10.1434
Funding
This work was supported by the Conselho Nacional de Desenvolvimento Científico e Tecnológico (KJ, #422500/2016–0), Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul (RAS, #17/2551–0001433-2 and #19/2551–0000689-6), and Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (FK, Fundação de Amparo à Pesquisa do Estado de São Paulo [# 2014/50891–1] and Conselho Nacional de Desenvolvimento Científico e Tecnológico [# 465458/2014–9]). TAC is grateful for her postdoctoral fellowship funding from the Canadian Institutes of Health Research (CIHR). This research was also supported by the Ontario Mental Health Foundation (Type-A Grant to BF) and from J.P. Bickell Foundation (Medical Research Grant to BF).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no competing interests.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
El Dahr, Y., de Azevedo Cardoso, T., Syan, S. et al. Investigating biological rhythms disruptions across the menstrual cycle in women with comorbid bipolar disorder and premenstrual dysphoric disorder. Arch Womens Ment Health 25, 345–353 (2022). https://doi.org/10.1007/s00737-022-01220-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00737-022-01220-0