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• W1569792514 abstract "The idea that a discussion among a group of experts at annual American College of Neuropsychopharmacology (ACNP) meeting would result in some clarity about Menstrually Related Disorders is so good spirited–as good spirited as ACNP meeting itself– that fearing I would find more or less what I did, I hesitated to read resulting report. I hesitate even more to offer my comments; who wants to rain on a picnic? On other hand, authors have chosen to publish this and in a format that invites scrutiny. So here goes. The points of consensus are indeed indisputable, but are they informative? Under Etiology and Pathophysiology, for example, we are told that the pathophysiology of MRDs is likely to be multidimensional and multifactorial, involving various physiologic and biochemical systems. I may be missing something, but as far as I can tell this bit of enlightenment applies to all of disorders that afflict us, gout to gonorrhea, paranoia to pediculosis. Likewise for vulnerability of affected patients plays a major role in development of specific subtypes and and environmental and psychologic factors probably contribute to development of symptoms as well as determination of their severity. That this stuff was actually written down, and for other people to read, I attribute to rosy glow endorsing all ACNP meeting activities. The proposed name, Menstrually Related Disorders, may well sound great to some ears. To me, it seems an unfortunate alliance of nonspecific terms, as unhappy a mouthful as late luteal phase dysphoric disorder. Under Diagnostic Criteria, points of consensus are sensible but singularly imprecise, and points of disagreement are incomprehensible, at least to me. Under of MRDs, points of consensus are indisputable and uninformative in equal measure. The points of debate under Etiology and Pathophysiology and areas of debate under treatment provide a list of pertinent research questions. These are most useful sections of document. To be fair, any group tackling this problem would probably produce as fuzzy a document. What seems most at issue is unstated: Is our nosology enhanced by addition of Menstrually Related Disorders? Given profound effects of gonadal steroids on cellular function, it should come as no surprise that signs and symptoms of a wide range of afflictions fluctuate in relation to menstrual cycle. But should these afflictions be combined as a diagnostic entity? The menstrual cycle is not alone as a natural phenomenon that influences course of disease. The weather influences expression of many illnesses, so does age. Our understanding of etiology, pathophysiology, prognosis, and treatment of disease is clearly enhanced by understanding effect of climate and age on expression of symptoms. However, I doubt that combining huge number of conditions influenced by climate and age into diagnostic categories–climate-related disorders and age-related disorders–adds usefully to our nosology. On other hand, some conditions are not just influenced or modified by climate or age; they require a specific climate or age for their expression. Seasonal affective disorder and Alzheimer's disease come to mind. Likewise, it may be worthwhile to identify conditions expression of which requires a specific phase of menstrual cycle and to differentiate these conditions from innumerable ones for which a phase of menstrual cycle is a risk or modifying factor. As far as I know, only disorder that bears an obligatory relationship to menstrual cycle is Premenstrual syndrome (PMS). It is estimated that 2% to 10% of menstruating women have disabling PMS (Logue and Moos 1986). The extent to which clinical and research communities have ignored PMS is all too clear in contrast between attention given to PMS and that given to major depression, a condition with a similar prevalence. Among reasons for paucity of attention to PMS may be that despite reasonable presumption that shifts in gonadal steroids account for this condition, researchers have been frustrated in their attempts to find an endocrine aberration in PMS, and, until recently, treatments directed toward this condition have been largely unsuccessful. I am dismayed at possibility that attention to ill-denned Menstrually Related Disorders which may not exist will drive PMS further into obscurity. Failure to uncover role of gonadal steroids in PMS impugns our current technology more than it does a hormonal basis for condition. Until we have methods for assessing in vivo effects of hormones at molecular level, role of gonadal steroids in PMS is likely to remain elusive. Treatment may be less elusive. Recent studies have consistently shown that compounds which potently block serotonin uptake are powerfully effective in treatment of PMS (Stone et al. 1991; Sundblad et al. 1992). Although studies to date have involved ad- ministration of these compounds throughout menstrual cycle, anecdotal evidence suggests that they may be effective when taken during premenstrual phase alone (Sundblad et al. 1992). Thus, these compounds appear to alleviate PMS more rapidly and perhaps via a different mechanism than they alleviate depression. The effectiveness and probable specificity of serotonin uptake inhibitors as a treatment for PMS provide a new probe for assessing pathophysiology of this condition. The effectiveness of this treatment also raises a number of pertinent and answerable clinical questions: When should these agents be administered and in what dose? Are serotonin uptake inhibitors effective and suitable for mild variants of PMS? Are other agents that enhance serotonin transmission effective in PMS? Do antidepressants that don't affect serotonin alleviate PMS? Are serotonin uptake inhibitors useful in treating other, oh, what heck, MRDs? ACKNOWLEDGMENT The author thanks Andrea Stone, M.D. for her useful comments on manuscript. REFERENCES Logue CM, Moos RH (1986): Perimenstrual symptoms: Prevalence and risk factors. Psychosom Med 48:388-414 Stone AB, Pearlstein TB, Brown WA (1991): Fluoxetine in treatment of late luteal phase dysphoric disorder. J Clin Psychiatry 52:290-293 Sundblad C, Modigh K, Andersch B, Eriksson ? (1992): Clomipramine effectively reduces premenstrual irritability and dysphoria: A placebo-controlled trial. ActaPsy-chiatr Scand 85:39-47" @default.
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• W1569792514 title "Commentary on “Menstrually Related Disorders: Points of Consensus, Debate, and Disagreement”" @default.
• W1569792514 doi "https://doi.org/10.1038/npp.1993.74" @default.
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