Journal of Basic and Clinical Reproductive Sciences

Journal of Basic and Clinical Reproductive Sciences
Mohamed Mk*, EL- Gharib MN and Dawood AS
 
Department of Obstetrics and Gynecology and Neuropsychiatry, Faculty of Medicine, Tanta University, Egypt
 
*Correspondence: Mohamed Mk, Department of Obstetrics and Gynecology and Neuropsychiatry, Faculty of Medicine, Tanta University, Egypt, Email: [email protected]

Received Date: Aug 24, 2017 / Accepted Date: Dec 08, 2017 / Published Date: Dec 12, 2017

Citation: Mohamed Mk,EL- Gharib MN and Dawood AS.The Effects of Sertraline on Premenstrual Tension Syndrome doi: 10.4103/2278-960X.194507

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Abstract

Background: Premenstrual Dysphoric disorder (PMDD) is a serious kind of premenstrual syndrome (PMS) that causes significant distress and interferes with normal operation. PMS disturbs about 75% of women of reproductive age.
Aim: The purpose of this work is to test the effect of Sertraline, Selective Serotonin Reuptake Inhibitors on electroencephalographic (EEG) patterns, and clinical manifestations in females with premenstrual tension syndrome.
Patients and methods: This prospective observational study was conducted on 200 female participants. Patients will be subdivided into two groups: Group A (control): includes 80 normal females and Group B consists of 120 patients with PMS. Patients with PMS were given sertraline 50 mg/day orally, initiated 14 days before the expected onset of menses and discontinued the day menses began. All patients were admitted in the study was less than 35 years old, have a BMI between 20 and 30, having regular cycles, not using drugs. The following methods were undertaken for each patient: Full history. Complete clinical examination, EEG was done twice for each patient, firstly, on the 7th day of the cycle (follicular phase) and secondly on day 21 of the cycle (luteal phase).
The results: The present study confirmed the presence of a significant difference in frontal alpha asymmetry between PMS and non-PMS women. Moreover, we found that sertraline has no significant effects on EEG findings, but relieved the clinical symptoms.
Conclusions: We strongly support the effectiveness of SSRIs in the treatment of PMS.

Keywords

Electroencephalogram, premenstrual dysphoric disorder, premenstrual tension, premenstrual syndrome, SSRI, sertraline.

Background

Premenstrual syndrome (PMS) is defined as a combination of physical and mood disturbances that take place in the last half of a woman's menstrual cycle after ovulation which normally ends with the menstrual flow. Premenstrual Dysphoric disorder (PMDD) is a severe form of premenstrual syndrome. PMDD occurs in 3% to 8% of menstruating women [1] . Epidemiologic surveys have estimated that 75 percent of women of reproductive age, experience some symptoms attributed to the premenstrual phase of the menstrual cycle. Most adult females are able to treat these symptoms through lifestyle changes and conservative therapies [2].The American Psychiatric Association has established formal guidelines for the diagnosis of PMDD in their Diagnostic and Statistical Manual (DSM-IV). The DSM-IV diagnostic criteria of PMDD require prospective documentation of symptoms being present for at least two consecutive menstrual cycles. At least one affective and one somatic symptom must be present and symptoms are relieved within 4 days without recurrence until cycle day 13 [3]. Some EEG study of adult females with PMS demonstrated that Frontal EEG asymmetry was recorded at rest and during affective picture viewing, once during lateral and once during follicular phases, in counterbalanced order [4]. El-Gharib and associated concluded that that resting luteal phase of EEG frontal asymmetry must be added to the research criteria for PMDD (DSM-IV-TR) [5]. Serotonin is a monoamine neurotransmitter. Biochemically derived from tryptophan, serotonin is primarily found in the gastrointestinal tract, blood platelets, and the cardinal nervous system. It is popularly thought to be a contributor to feelings of well-being and happiness [6].Evidence implicates the serotonergic system, in particular in the pathogenesis of premenstrual dysphoric disorder, which is considered to be associated with symptoms such as irritability, depressed mood, and carbohydrate craving [7]. Selective serotonin reuptake inhibitors (SSRIs) are considered to increase the extracellular levels of the neurotransmitter serotonin by inhibiting its reuptake into the presynaptic cells and thus increasing the measure of serotonin available to attach to the postsynaptic receptor. SSRIs are most usually used as antidepressants and anxiety disorders [8]. Numerous studies with a double-blind, randomized, confirm that SSRIs improves the quality of life of women with PMDD [9]. The main aim of this work is to study the effect of Selective Serotonin Reuptake Inhibitors on electroencephalographic patterns, and clinical manifestations in females with premenstrual tension syndrome.

Patients and Methods

This prospective observational cohort study was conducted on 160 women from those serving the Department of Obstetrics and Gynecology, Tanta University Hospital. Recruitment of the chess sets out in November 2015 and was completed in July 2016.The two hundred patients included in this open area, subdivided into two groups: Group A (control):includes 80 normal females and Group B (patient): includes 120 patients with premenstrual tension syndrome. All patients were included in the study was less than 35 years old, have a BMI between 20 and 30, having regular cycles, not using drugs (particularly ovulatory induction drugs, hormonal contraception, serotonin reuptake inhibitors and other drugs affecting CNS) during the last six months, do not cause neurological or psychiatric problems, if they owned a previous operation of the brain or spinal cord. All patients submitted to the study were counseled thoroughly about the procedure including nature, value, and fates of the investigation and the aim of the study. After this, a written consent will be obtained and signed by the patient. We did not receive any funds, from any individual or institution. If the patient refused to complete the study, she was contracted away and replaced by another one from who are satisfying the inclusion criteria of the study. We did not classify the patients according to their religious belief or culture or race or any other inside information. Once women were admitted in the study, they were asked about their current phase of the cycle, by calculating backward from the starting day of the next expected period. PMDD was diagnosed by the daily symptom report [10]. Patients with PMS were given sertraline 50 mg/day orally, initiated 14 days before the expected onset of menses and discontinued the day menses began.

Methods

The Following Methods Were Undertaken For Each Patient:

• Full story.

• Performing thorough clinical general.

• obtaining routine investigations.

• Electroencephalography (EEG). EEG was recorded using (NIHON KHODEN Machine, EEG 9000 version 0.5-71 Japan).

Firstly, we prepared and clean the scalp of the patient from oil and any debris or draft, Then 21 sliver-chloride electrodes were applied to the head surface and they were adherent to the scalp by using an adhesive conductive paste (10-20 paste). These electrodes were put on to the scalp according to 10-20 system. Hyperventilation and photic stimulation were applied as a provocation methods during EEG recording. These signals from the surface electrodes will pass through an amplifier that converts them from parallel to digital ones which can be displayed and stored in a computer [11]. EEG was performed twice for each patient, firstly, on the 7th day of the cycle (follicular phase) and secondly on day 21 of the cycle (luteal phase.)

Results

The results of this study are depicted in 6 tables and 5 figures.

Discussion

The contemporaneous study showed a significant difference in frontal alpha asymmetry between PMS and non-PMS women and a difference between right and left hemisphere alpha activities in the luteal phase. In addition, negative affect and somatic depression were related to frontal alpha asymmetry. In that placement were more severe premenstrual distress and depressive symptoms during the luteal phase than during the follicular phase, as well as more severe premenstrual distress and depressive symptoms in PMS than in non- PMS [Tables 1-3 and Figures 1-3].

  Number Range Mean ± SD
Age Control group 80 20-35 27.525 4.7447
PMS group 120 21-34 27.325 4.6233
BMI Control group 80 22-28 25.075 2.0049
PMS group 120 21-27 25.025 2.0231

Table 1: Age and body mass index of the studied patients.

Variables WithPMS/PMDD       Without t.test P.value
-120 PMS/PMDD(80) orX2
Presentage(inyears) 27.3±4.985 27.75±4.61 0.6349 0.2241
Ageatmenarche(inyears) 13.05±1.395 13.3±1.455 0.4751 0.8519
Numberofbleedingdays 5.9±1.165 5.7±1.129 1.3248 0.1141
Lengthofcycle(indays) 26.65±2.455 25.85±2.641 1.9651 0.2239
Numberofyearswith 3.3±0.801 3.25±0.786 0.8589 0.9511
premenstrualSymptoms
Dysmenorrhea:     2.0411 0.1519
Yes                  102 56
No                    18 24
The Intensityofdysmenorrhea:     0.621 0.7321
Mild                 78 40
Moderate                 30 28
Severe                 12 12
Familyhistory:     5.149 0.024
Yes               108 48
No                 12 32

Table 2: Reproductive characteristics of study subjects.

       Mild     Moderate      Severe X2 P.
N % N % N % value
Depressed,sad,“down” 96 80 18 15 6 5 4.2529 0.0151
or“blue”feelingof
worthlessorguilty
Anxious,tense,“keyed 108 90 6 5 6 5 2.6319 0.0511
up”oronedge
Moodswings/sensitive 84 70 24 20 12 10 7.5261 0.0489
torejection
Anger,orirritable 84 70 12 10 24 20 2.6321 0.0949
Lessinterestinusual 102 85 36 5 12 10 5.4119 0.0091
activities
Lackofconcentration 72 60 24 20 24 20 3.1471 0.0279
Lethargic,tired,fatigued 60 50 48 40 12 10 152 0.147
orofenergy
Increasedappetiteor 72 60 42 35 6 5 1.2011 0.3319
foodcravings
Insomnia/hypersomnia 54 45 54 45 12 10 0.3019 0.1141
Overwhelmed,unableto 78 65 18 15 24 20 2.8851 0.0159
cope
Breasttenderness,breast 8 40 60 50 12 10 4.5229 0.0271
swelling,bloated
sensation,weightgain,
headache,jointor
musclepain,orother
physicalsymptoms
Reductionof 14 70 12 10 24 20 5.6389 0.021
productivityor
inefficiencyatwork,
school,homeorindaily
routine
Lessparticipationin 11 55 36 30 18 15 2.031 0.0119
hobbiesorsocial
activities
Interferencein 17 85 6 5 12 10 2.3359 0.0741
relationships with others

Table 3: The Prem.

clinical-reproductive-sciences-frequency

Figure 1: The frequency of symptoms among subjects with premenstrual tension syndrome.

clinical-reproductive-sciences-Premenstrual

Figure 2: Premenstrual symptoms in PMS / PMDD patients, according to severity.

clinical-reproductive-sciences-tension

Figure 3: EEG patterns, ratio in premenstrual tension syndrome in patient during follicular and luteal phases.

In judgement with previous studies, [4] the present study examined the participants' EEG not only under the resting baseline, but also during the depressive induction and relaxation conditions. According to the Davidson's theory, frontal alpha asymmetry reveals relatively higher left than right frontal alpha activity during depressive moods in major depressive disorders. Furthermore, Baehr et al. & Accortt et al., [12] also confirmed higher left than right frontal alpha activity under the resting baseline in a diagnostic PMDD group. The finding of this study and those of the previous studies concur that frontal alpha asymmetry significantly differed between PMDD and non- PMDD. All the participants of the present survey are of childbearing age and experienced regular menstrual cycles. We propose that the difference found in frontal alpha asymmetry may be made by one of the pathophysiological mechanisms underlying PMS. This agrees with the findings of Davidson [13] who indicated that frontal alpha asymmetry was related to metabolic activity in the amygdala (part of the limbic system), which was linked to emotion regulation. In the existing study, we found no significant correlation between EEG findings and the clinical manifestation of PMS [Tables 4-6 and Figures 4 and 5]. Numerous treatment modalities have been shown to be effective in the treatments of PMS, and counseling, including psychotherapy, medications as SSRIs (selective serotonin reuptake inhibitors). SSRIs are the most effective medication available at the present for treating PMDD, hormonal therapies, including oral contraceptive pills, danazol, GnRh analogue, progesterone, progestogens and surgical removal of the ovaries [14]. Selective serotonin reuptake inhibitors (SSRIs) are currently considered the most effective pharmacologic class for the treatment of symptoms related to severe premenstrual syndrome (PMS) and its most intense form, premenstrual Dysphoric disorder [15]. Despite the conduct of systematic reviews supporting SSRI efficacy, sources of heterogeneity between studies have not been elucidated in prior meta-analyses [16]. The SSRIs, including sertraline, represent an important advance in the pharmacotherapy of mood and other disorders. They are chemically unrelated to tricyclic, heterocyclic, and other first-generation antidepressants. SSRIs are the treatment of choice for many indications, including premenstrual dysphoric disorder, because of their efficacy, good side-effect profile, tolerability, and safety in overdose, as well as patient compliance [17]. In the current study, we gave sertraline drugs for treating cases with PMDD in a dose of 50 mg once daily starting from the 14th days till menstruation occurred, for 3 cycles. We found amelioration of symptoms in 60% of cases. These results come to an agreement with the results of several authors [18-20]. Opportunely, we did confront with any side effects to sertraline administration. This differs from the results of other authors [21-23] . To finish, we conclude that sertraline is an effective medicament for PMDD.

  Number of patients No of Abnormal EEG %
PMS 102 60 58.82
PMMD 18 6 33.33

Table 4: Comparison between EEG finding in PMS and PMDD cases.

  PMS PMDD
Background activity 0 0
Sharp and slow wave activity 12 0
Spike and slow wave activity 0 0
Slow wave activity 0 0
Frontal discharge asymmetry 48 6

Table 5: Abnormal EEG finding in study group.

  Number Get better
Abnormal EEG 60 36

Table 6: The Effects of Selective Serotonin Reuptake Inhibitors on EEG Findings in Females with Premenstrual Tension Syndrome.

clinical-reproductive-sciences-abnormal

Figure 4: The abnormal EEG finding in study group.

clinical-reproductive-sciences-Syndrome

Figure 5: The Effects of Selective Serotonin Reuptake Inhibitors on EEG Findings in Females with Premenstrual Tension Syndrome.

Declaration of Conflict of Interest

The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper.

References



Annals of Medical and Health Sciences Research Journal of Basic and Clinical Reproductive Sciences a publication of Society of Reproductive Biologist of Nigeria, is a peer-reviewed online journal with Semiannual print on demand compilation of issues published.
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