Comorbid Premenstrual Dysphoric Disorder in Women with Bipolar Disorder: Management Challenges

Gianna Sepede,1 Marcella Brunetti,1 Massimo Di Giannantonio1,2 1Department of Neuroscience, Imaging, and Clinical Sciences, University “G. d’Annunzio”, Chieti, Italy; 2Department of Mental Health - Chieti, National Health Trust, Chieti, ItalyCorrespondence: Gianna Seped...

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Autores principales:	Sepede G, Brunetti M, Di Giannantonio M
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	women health comorbid mood disorders combined intervention treatment challenges Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/ba150a6ad0ad45fdb890f67e3402477a
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spelling	oai:doaj.org-article:ba150a6ad0ad45fdb890f67e3402477a2021-12-02T04:53:57ZComorbid Premenstrual Dysphoric Disorder in Women with Bipolar Disorder: Management Challenges1178-2021https://doaj.org/article/ba150a6ad0ad45fdb890f67e3402477a2020-02-01T00:00:00Zhttps://www.dovepress.com/comorbid-premenstrual-dysphoric-disorder-in-women-with-bipolar-disorde-peer-reviewed-article-NDThttps://doaj.org/toc/1178-2021Gianna Sepede,1 Marcella Brunetti,1 Massimo Di Giannantonio1,2 1Department of Neuroscience, Imaging, and Clinical Sciences, University “G. d’Annunzio”, Chieti, Italy; 2Department of Mental Health - Chieti, National Health Trust, Chieti, ItalyCorrespondence: Gianna SepedeDepartment of Neuroscience, Imaging, and Clinical Sciences, University “G. d’Annunzio”, Via Dei Vestini 33, Chieti, Chieti Scalo (CH) 66013, ItalyTel +39 0871 3556901Fax +39 0871 3556930Email g.sepede@unich.itAbstract: Bipolar disorder (BD) and premenstrual dysphoric disorder (PMDD) are two cyclic mood illnesses, sometimes presenting together. Their comorbidity appears to be linked to common biological mechanisms and usually results in more severity of mood symptoms and a poorer long-term outcome. Nevertheless, the management of comorbid PMDD/BD has been scarcely studied. Therefore, the aim of the present paper was to review the published literature on the treatment of comorbid PMDD/BD and to provide point-by-point hypotheses to address these complex clinical cases. We searched PubMed to identify the studies focused on the treatment and management of comorbid PMDD/BD using the following search words, alone and in combination: premenstrual dysphoric disorder, bipolar disorder, comorbid, treatment, management, pharmacotherapy, psychotherapy. The search was conducted on the 1st of June 2019 and yielded 55 records. Four papers met our inclusion/exclusion criteria and were therefore included in our qualitative synthesis. Integrating the few data pertaining to the treatment of comorbid PMDD/BD with the large amount of published data on the two conditions separately, we can suggest that the management of comorbid PMDD/BD needs as a first step to stabilize the bipolar symptoms by means of optimal dosages of mood stabilizers. Then, in euthymic BD patients, the PMDD symptoms could be treated with estroprogestins (first-line treatment). On the contrary, during acute phases of BD, antidepressants (for major depressive episodes) and atypical antipsychotics/hormonal modulators (for manic episodes) could be considered as promising add-on treatments to mood stabilizers. In case of resistant PMDD/BD symptoms, combined strategies should be taken into account, as well as alternative treatments, such as lifestyle changes. In conclusion, RCTs on comorbid PMDD/BD are still lacking. The management of this complex condition is therefore challenging and it requires a tailored treatment.Keywords: womens’ health, comorbid mood disorders, combined intervention, treatment challengesSepede GBrunetti MDi Giannantonio MDove Medical Pressarticlewomen healthcomorbid mood disorderscombined interventiontreatment challengesNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol Volume 16, Pp 415-426 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	women health comorbid mood disorders combined intervention treatment challenges Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	women health comorbid mood disorders combined intervention treatment challenges Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Sepede G Brunetti M Di Giannantonio M Comorbid Premenstrual Dysphoric Disorder in Women with Bipolar Disorder: Management Challenges
description	Gianna Sepede,1 Marcella Brunetti,1 Massimo Di Giannantonio1,2 1Department of Neuroscience, Imaging, and Clinical Sciences, University “G. d’Annunzio”, Chieti, Italy; 2Department of Mental Health - Chieti, National Health Trust, Chieti, ItalyCorrespondence: Gianna SepedeDepartment of Neuroscience, Imaging, and Clinical Sciences, University “G. d’Annunzio”, Via Dei Vestini 33, Chieti, Chieti Scalo (CH) 66013, ItalyTel +39 0871 3556901Fax +39 0871 3556930Email g.sepede@unich.itAbstract: Bipolar disorder (BD) and premenstrual dysphoric disorder (PMDD) are two cyclic mood illnesses, sometimes presenting together. Their comorbidity appears to be linked to common biological mechanisms and usually results in more severity of mood symptoms and a poorer long-term outcome. Nevertheless, the management of comorbid PMDD/BD has been scarcely studied. Therefore, the aim of the present paper was to review the published literature on the treatment of comorbid PMDD/BD and to provide point-by-point hypotheses to address these complex clinical cases. We searched PubMed to identify the studies focused on the treatment and management of comorbid PMDD/BD using the following search words, alone and in combination: premenstrual dysphoric disorder, bipolar disorder, comorbid, treatment, management, pharmacotherapy, psychotherapy. The search was conducted on the 1st of June 2019 and yielded 55 records. Four papers met our inclusion/exclusion criteria and were therefore included in our qualitative synthesis. Integrating the few data pertaining to the treatment of comorbid PMDD/BD with the large amount of published data on the two conditions separately, we can suggest that the management of comorbid PMDD/BD needs as a first step to stabilize the bipolar symptoms by means of optimal dosages of mood stabilizers. Then, in euthymic BD patients, the PMDD symptoms could be treated with estroprogestins (first-line treatment). On the contrary, during acute phases of BD, antidepressants (for major depressive episodes) and atypical antipsychotics/hormonal modulators (for manic episodes) could be considered as promising add-on treatments to mood stabilizers. In case of resistant PMDD/BD symptoms, combined strategies should be taken into account, as well as alternative treatments, such as lifestyle changes. In conclusion, RCTs on comorbid PMDD/BD are still lacking. The management of this complex condition is therefore challenging and it requires a tailored treatment.Keywords: womens’ health, comorbid mood disorders, combined intervention, treatment challenges
format	article
author	Sepede G Brunetti M Di Giannantonio M
author_facet	Sepede G Brunetti M Di Giannantonio M
author_sort	Sepede G
title	Comorbid Premenstrual Dysphoric Disorder in Women with Bipolar Disorder: Management Challenges
title_short	Comorbid Premenstrual Dysphoric Disorder in Women with Bipolar Disorder: Management Challenges
title_full	Comorbid Premenstrual Dysphoric Disorder in Women with Bipolar Disorder: Management Challenges
title_fullStr	Comorbid Premenstrual Dysphoric Disorder in Women with Bipolar Disorder: Management Challenges
title_full_unstemmed	Comorbid Premenstrual Dysphoric Disorder in Women with Bipolar Disorder: Management Challenges
title_sort	comorbid premenstrual dysphoric disorder in women with bipolar disorder: management challenges
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/ba150a6ad0ad45fdb890f67e3402477a
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Comorbid Premenstrual Dysphoric Disorder in Women with Bipolar Disorder: Management Challenges

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