Anxiety Disorders: Rapkin AJ

Rapkin AJ, Mikacich JA. · Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-1740, USA. · Curr Opin Obstet Gynecol. · Pubmed #18797268 No free full text.

Abstract: PURPOSE OF REVIEW: To review the current knowledge about the prevalence, diagnosis, and management of premenstrual syndromes in adolescents. RECENT FINDINGS: Large epidemiologic studies addressing adolescent premenstrual disorders, clinical presentation, and comorbidity with other disorders have yet to be performed. Randomized controlled treatment trials for teens with moderate-to-severe premenstrual syndrome or the more severe affective predominant, premenstrual dysphoric disorder still are sorely lacking. This review will present an updated review of the published studies with respect to premenstrual syndrome and premenstrual dysphoric disorder in adolescents in the context of the large body of literature regarding presentation, diagnosis, and treatment in adult women. SUMMARY: Premenstrual disorders likely start in the teen years. At least 20% of adolescents may experience moderate-to-severe premenstrual symptoms associated with functional impairment. Current treatment includes lifestyle recommendations and pharmacologic agents that suppress the rise and fall of ovarian steroids or augment serotonin.

Rapkin AJ, Winer SA. · Department of Obstetrics & Gynecology, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, California 90095-1740, USA. · Expert Opin Pharmacother. · Pubmed #18220493 No free full text.

Abstract: Premenstrual dysphoric disorder (PMDD) is characterized by physical, affective and behavioral symptoms that are linked to the luteal phase of the menstrual cycle and relieved soon after the onset of menses. The disorder is chronic and exerts a major impact on personal relationships and occupational productivity for the estimated 6% of reproductive-aged women who fulfill strict PMDD criteria and the almost 20% of women who nearly meet these criteria. There are now various pharmacologic options that have demonstrated efficacy for PMDD and two of these approaches have an approved indication for treatment from the US FDA: three selective serotonin re-uptake inhibitors; and for women who also desire hormonal contraception, a low dose oral contraceptive pill containing the progestin drospirenone, in a new dosing regimen. Due to the unique pathophysiology of the disorder, the selective serotonin re-uptake inhibitors can be effectively administered intermittently, with dosing limited to the luteal phase of the cycle (2 weeks prior to menses). In the future, new pharmacotherapy will likely evolve from research evaluating other hormonal formulations that inhibit ovulation, without simulating PMDD-like symptoms, or novel pharmacologic agents that modulate the central neurotransmission.

Rapkin AJ, Biggio G, Concas A. · Department of Obstetrics and Gynecology, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States. · Pharmacol Biochem Behav. · Pubmed #16854457 No free full text.

Abstract: A deregulation in the peripheral and brain concentrations of neuroactive steroids has been found in certain pathological conditions characterized by emotional or affective disturbances, including major depression and anxiety disorders. In this article we summarize data pertaining to the modulatory effects of oral contraceptive treatment on neuroactive steroids in women and rats. Given that the neuroactive steroids concentrations are reduced by oral contraceptives, together with the evidence that a subset of women taking oral contraceptives experience negative mood symptoms, we propose the use of this pharmacological treatment as a putative model to study the role of neuroactive steroids in the etiopathology of mood disorders. Moreover, since neuroactive steroids are potent modulators of GABA(A) receptor function and plasticity, the treatment with oral contraceptives might also represent a useful experimental model to further investigate the physiological role of these steroids in the modulation of GABAergic transmission.

Rapkin AJ, Mikacich JA, Moatakef-Imani B, Rasgon N. · Department of Obstetrics and Gynecology, University of California, Los Angeles Medical Center, Box 951740, 27-139 CHS, Los Angeles, CA 90095, USA. · Curr Psychiatry Rep. · Pubmed #12441021 No free full text.

Abstract: Various mood and anxiety disorders are more prevalent in reproductive-aged women, and appear to be linked to hormonal and reproductive events. Premenstrual affective disorders consist of premenstrual syndrome, premenstrual dysphoric disorder, and premenstrual exacerbation of mood or anxiety disorders. Postpartum affective disorders can range from postpartum "blues" to postpartum depression with or without psychosis, and also include anxiety disorders, such as panic disorder, generalized anxiety disorder, social phobia, and obsessive-compulsive disorder. In perimenopausal women, the vulnerability to mood and anxiety disorders is increased. All of these disorders share risk factors, and have etiologic features in common, such as exposure to the rise and fall of ovarian sex steroids. The following is a review of these syndromes and their etiology, diagnosis, and treatment.

Rapkin AJ, Morgan M, Sogliano C, Biggio G, Concas A. · Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California 90095-1740, USA. · Fertil Steril. · Pubmed #16580672 No free full text.

Abstract: OBJECTIVE: To evaluate the effects of a low-dose combined oral contraceptive pill (OCP) on peripheral neuroactive steroid concentrations, precursors for neuroactive steroid synthesis, and mood in healthy women desiring contraception. These neuroactive steroids are gamma-aminobutyric acid receptor agonists and are important in the modulation of affect and adaptation to stress. DESIGN: Prospective observational study. SETTING: Human ambulatory patient study. PATIENT(S): Healthy OCP-naive women without current or history of affective disorder. INTERVENTION(S): A 0.020-mg ethinyl E2-0.1-mg levonorgestrel containing OCP for 3 months. MAIN OUTCOME MEASURE(S): Serum neuroactive steroids allopregnanolone, allotetrahydrodeoxycorticosterone, and DHEA; neuroactive steroid precursors P and pregnenolone; E2; and mood and anxiety as assessed by the Premenstrual Syndrome Daily Ratings Form, Beck Depression Inventory, Spielberger State-Trait Anxiety Inventory, and Profile of Mood States. RESULT(S): The combined OCP resulted in a decrease in neuroactive steroids and neuroactive steroid precursors as well as in E2. However, this decline was not associated with adverse mood changes on any of the well-validated assessment tools. CONCLUSION(S): Healthy women without underlying mood or anxiety disorder who were given a low-dose OCP did not experience adverse psychological symptoms despite a significant reduction in neuroactive steroids.

Rapkin AJ, Winer SA. · Professor of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA. · Expert Rev Pharmacoecon Outcomes Res. · Pubmed #19402804 No free full text.

Abstract: Premenstrual symptoms are distressing for up to 20% of reproductive-aged women and are associated with impairment in interpersonal or workplace functioning for at least 3-8%. Typical symptoms of premenstrual syndrome and the severe form, premenstrual dysphoric disorder, include irritability, anger, mood swings, depression, tension/anxiety, abdominal bloating, breast pain and fatigue. The symptoms recur monthly and last for an average of 6 days per month for the majority of the reproductive years. For women with premenstrual dysphoric disorder, the symptoms can be as disabling as major depressive disorder. It has been estimated that affected women experience almost 3000 days of severe symptoms during the reproductive years. Until two decades ago, there were no effective treatments for severe premenstrual syndrome. Even in 2000, almost three-quarters of women in the USA with premenstrual disorders either did not seek help or sought treatment unsuccessfully from at least three clinicians for over 5 years. This review will focus on the epidemiology, diagnosis, treatment outcomes, quality of life and burden of illness for premenstrual disorders.

Rapkin AJ, Tsao JC, Turk N, Anderson M, Zeltzer LK. · Department of Obstetrics and Gynecology, Los Angeles, California 90095, USA. · J Pediatr Adolesc Gynecol. · Pubmed #16731411 No free full text.

Abstract: STUDY OBJECTIVE: Females are more likely than males to suffer from various mood and pain disorders. However, this female predominance does not appear to develop until puberty. The purpose of the present study was to examine the associations among hormone concentrations, self-rated Tanner staging and dysmenorrhea, and to determine whether various psychosocial factors modulate these relationships. DESIGN: As part of a larger prospective study of the influence of puberty on laboratory pain response, Tanner ratings, estradiol and follicle stimulating hormone concentrations, dysmenorrhea and psychosocial parameters including depression, anxiety, somatization, and socioeconomic status were observed. PARTICIPANTS: 124 healthy girls ages 8 to 18 were evaluated. MAIN OUTCOME MEASURE: There were significant correlations between pubertal status utilizing self-rated diagrams of Tanner stage and hormonal markers of pubertal development, specifically estradiol and FSH. Tanner stage but not estradiol was correlated with presence of dysmenorrhea. There was no effect of body mass index (BMI), socioeconomic status (SES), anxiety, depression, or somatization on presence or absence of painful menses. There was no correlation between BMI or SES and age of menarche. However, Tanner stage was correlated with BMI but not with SES. RESULTS AND CONCLUSIONS: Tanner self-staging is at least as accurate as estradiol and FSH measurements alone in evaluating healthy female adolescents' physical changes and menstrual pain. Tanner self-ratings are thus particularly useful in large, epidemiologic, or cross cultural studies where physical examination and blood sampling may not be feasible due to cost, access, or psychosocial barriers.