title: The clinical relevance of self-reported premenstrual worsening of depressive symptoms in the management of depressed outpatients: a STAR*D report.
abstract: OBJECTIVE
  To determine the incidence, clinical and demographic correlates, and relationship to treatment outcome of self-reported premenstrual exacerbation of depressive symptoms in premenopausal women with major depressive disorder who are receiving antidepressant medication.
  
  
  METHODS
  This post-hoc analysis used clinical trial data from treatment-seeking, premenopausal, adult female outpatients with major depression who were not using hormonal contraceptives. For this report, citalopram was used as the first treatment step. We also used data from the second step in which one of three new medications were used (bupropion-SR [sustained release], venlafaxine-XR [extended release], or sertraline). Treatment-blinded assessors obtained baseline treatment outcomes data. We hypothesized that those with reported premenstrual depressive symptom exacerbation would have more general medical conditions, longer index depressive episodes, lower response or remission rates, and shorter times-to-relapse with citalopram, and that they would have a better outcome with sertraline than with bupropion-SR.
  
  
  RESULTS
  At baseline, 66% (n=545/821) of women reported premenstrual exacerbation. They had more general medical conditions, more anxious features, longer index episodes, and shorter times-to-relapse (41.3 to 47.1 weeks, respectively). Response and remission rates to citalopram, however, were unrelated to reported premenstrual exacerbation. Reported premenstrual exacerbation was also unrelated to differential benefit with sertraline and bupropion-SR.
  
  
  CONCLUSIONS
  Self-reported premenstrual exacerbation has moderate clinical utility in the management of depressed patients, although it is not predictive of overall treatment response. Factors that contribute to a more chronic or relapsing course may also play a role in premenstrual worsening of major depressive disorder (MDD).
authors.affiliation: Duke-NUS Graduate Medical School Singapore, Singapore.
authors.forename: Charlotte L
authors.initials: CL
authors.lastname: Haley
authors.forename: Sharon C
authors.initials: SC
authors.lastname: Sung
authors.forename: A John
authors.initials: AJ
authors.lastname: Rush
authors.forename: Madhukar H
authors.initials: MH
authors.lastname: Trivedi
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Wisniewski
authors.forename: James F
authors.initials: JF
authors.lastname: Luther
authors.forename: Susan G
authors.initials: SG
authors.lastname: Kornstein
mesh_terms: D000293:Adolescent; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology*; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000523:psychology*; D005260:Female; D006801:Humans; D015994:Incidence; D008597:Menstrual Cycle / Q000523:psychology*; D010045:Outpatients / Q000523:psychology; D017697:Premenopause / Q000523:psychology; D057566:Self Report; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents