Hormonal Causes of Menstrual-Related Mood Disorders
|First Received Date ICMJE||December 29, 2004|
|Last Updated Date||May 8, 2015|
|Start Date ICMJE||December 2004|
|Primary Completion Date||Not Provided|
|Current Primary Outcome Measures ICMJE||Not Provided|
|Original Primary Outcome Measures ICMJE||Not Provided|
|Change History||Complete list of historical versions of study NCT00100360 on ClinicalTrials.gov Archive Site|
|Current Secondary Outcome Measures ICMJE||Not Provided|
|Original Secondary Outcome Measures ICMJE||Not Provided|
|Current Other Outcome Measures ICMJE||Not Provided|
|Original Other Outcome Measures ICMJE||Not Provided|
|Brief Title ICMJE||Hormonal Causes of Menstrual-Related Mood Disorders|
|Official Title ICMJE||5HT1A and SERT Imaging During Pharmacologically Induced Hypogonadotropic Hypogonadism With and Without Estrogen and Progesterone Replacement|
This study will explore possible hormonal causes of menstrual-related mood disorders (MRMD) by stopping the menstrual cycle with a drug called Lupron and then giving in sequence two menstrual cycle hormones, progesterone and estrogen. The study will first evaluate Lupron's effectiveness in treating MRMD and will then examine the effects of giving estrogen and progesterone on mood and behavior. In addition, positron emission tomography (PET) and magnetic resonance imaging (MRI) will be used to study serotonin receptors and transporters - molecules in the brain that are thought to play a major role in mood changes related to the menstrual cycle.
Menstruating women between 18 and 50 years of age who are in good health, not pregnant, and not taking medications may be eligible for this study. Women with MRMD must have had at least moderately severe MRMD or behavioral disturbances for at least 6 months within 2 years of entering the study. Healthy controls must have no history of MRMD or behavioral disturbances. Candidates undergo physical and neurological examinations, chest x-ray, electrocardiogram, and blood and urine tests. Results of a recent Pap smear (no longer than 12 months before beginning the study) must be available.
Participants undergo the following tests and procedures:
The central serotonergic (5HT) system is one of the candidate systems that may mediate the abnormal mood and behavioral response to ovarian steroids observed in women with menstrual-related mood disorders (MRMD). Numerous studies have attempted to measure 5HT system function in women with MRMD and controls; however, previous studies were restricted to the evaluation of indirect measures of 5HT function (e.g., platelet 5HT uptake or responses to serotonergic pharmacologic challenges). Radioligand imaging of specific components of the 5HT system currently represents the most direct measure of central serotonergic function available. In this study we will image serotonergic measures during pharmacological conditions previously demonstrated to induce a remission and a subsequent provocation of mood symptoms in women with MRMD but not controls.
This protocol has two outcome measures (5HT(1A) binding and SERT binding), two groups of subjects (women with MRMD and controls), and three distinct hormonal conditions (hypogonadism, estrogen replacement, and progesterone replacement). Our principal aim in this study is to investigate differences in the outcome measures in women with MRMD compared to controls. Our primary hypothesis is that 5HT(1A) binding will be decreased and SERT binding will be increased in women with MRMD. A secondary hypothesis is that women with MRMD, but not controls, will display reproductive steroid modulation of 5HT(1A) and SERT binding. This study will help test existing hypotheses about the pathophysiologic relevance of serotonin function in MRMD and the role of reproductive steroids in serotonergic regulation. First, we selected 5HT(1A) receptor binding as an outcome measure for the following reasons: 5HT(1A) function is modulated by both estradiol and progesterone, abnormalities of 5HT(1A) binding have been reported in both depressive and anxiety disorders as well as possibly MRMD, 5HT(1A) receptors have been identified as potential mediators of estradiol's antidepressant-like effects in the forced swim test, and the 5HT(1A) system is involved in the regulation of GABA activity abnormalities of which have been implicated in MRMD. Second, we selected SERT binding as an outcome measure for the following reasons: selective serotonin reuptake inhibitors, but not traditional antidepressants, are effective treatments for MRMD; abnormalities of SERT binding have been reported in depressive disorders in women, preliminary data suggest that women with MRMD are characterized by an elevated frequency of the long, more transcriptionally active polymorphism of the serotonin transporter (5HTTLPR) (Roca et al); women with MRMD have altered imipramine binding and platelet 5HT uptake compared to controls as well as altered platelet paroxetine binding (which normalize with successful treatment with GnRH agonist); and, finally, SERT message, binding and protein have been reported to be changed by ovarian steroids in preclinical studies.
We hypothesize that the effects of hormonal condition on 5HT(1A) (receptor) binding will differ in patients and controls. Specifically, we anticipate that 5HT1A binding will be decreased in hippocampus and prefrontal cortex in patients with MRMD but not controls. Such a decrease, if a trait characteristic, will be demonstrable irrespective of hormonal state. However, as symptoms of MRMD are directly precipitated by estradiol or progesterone (see below), it is possible that symptoms are accompanied by state and steroid-dependent changes in 5HT(1A) binding and function. Consequently, our secondary hypothesis is that estradiol or progesterone induces changes in 5HT(1A) (receptor) binding in women with MRMD but not in control women.
Similarly, we hypothesize that women with MRMD will have increased SERT binding activity compared to controls, consistent with the therapeutic efficacy of selective serotonin reuptake inhibitors in this condition. However, a secondary hypothesis is that estradiol or progesterone-induced changes in SERT binding will occur in a hormone-dependent and mood state-dependent manner. Specifically, consistent with the literature in rodents, acute changes in ovarian steroids will increase SERT binding in association with the induction of symptoms in women with MRMD but not controls.
|Study Type ICMJE||Observational|
|Study Design ICMJE||Not Provided|
|Target Follow-Up Duration||Not Provided|
|Sampling Method||Not Provided|
|Study Population||Not Provided|
|Intervention ICMJE||Not Provided|
|Study Group/Cohort (s)||Not Provided|
* Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
|Recruitment Status ICMJE||Active, not recruiting|
|Completion Date||Not Provided|
|Primary Completion Date||Not Provided|
|Eligibility Criteria ICMJE||
Women who meet the criteria for MRMD will have participated in Protocol No. 81-M-0126, The Evaluation of Women with Menstrually Regulated Mood and Behavior Disorders:
Women with MRMD:
All patients participating in this protocol will have already participated in protocol No. 81-M-0126 and will have a prospectively confirmed and predictable relationship between their mood disorder and the premenstrual phase of the menstrual cycle; i.e., a 30% change in severity of symptom self rating scales, relative to the range of the scale employed, during the seven days premenstrually compared with the seven days post-menstrually in two out of three months of study.
Women without MRMD:
--Complete blood count; thyroid function tests; renal function tests, such as BUN and creatinine; electrolytes; glucose; liver function tests, B-hCG for pregnancy test.
The following conditions will constitute contraindications to treatment with hormonal therapy and will preclude a subject's participation in this protocol.
Further, subjects will be warned not to become pregnant during the study and will be required to employ barrier contraceptive methods.
|Ages||18 Years to 45 Years|
|Accepts Healthy Volunteers||Yes|
|Contacts ICMJE||Contact information is only displayed when the study is recruiting subjects|
|Listed Location Countries ICMJE||United States|
|Removed Location Countries|
|NCT Number ICMJE||NCT00100360|
|Other Study ID Numbers ICMJE||050059, 05-M-0059|
|Has Data Monitoring Committee||Not Provided|
|Responsible Party||National Institutes of Health Clinical Center (CC) ( National Institute of Mental Health (NIMH) )|
|Study Sponsor ICMJE||National Institute of Mental Health (NIMH)|
|Collaborators ICMJE||Not Provided|
|Information Provided By||National Institutes of Health Clinical Center (CC)|
|Verification Date||April 2015|
ICMJE Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP