Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States.
Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
Front Endocrinol (Lausanne). 2023 May 18;14:976050. doi: 10.3389/fendo.2023.976050. eCollection 2023.
Studies in estrogen deficiency states such as primary ovarian insufficiency and Turner syndrome suggest that estrogen status may be an important modulator of mood and emotions. In this study we compared depressive and anxiety symptoms between adolescent and young adult female oligo-amenorrheic athletes (AA) and eumenorrheic females (EM), and explored structural, and functional changes in related brain areas during reward processing, a behavioral construct that is altered in depression and anxiety.
We included (i) 24 AA participating in ≥4 hours/week of aerobic exercise or running ≥20 miles/week for ≥6 months in the preceding year, with lack of menstrual cycles for ≥3 months within at least 6 preceding months of oligo-amenorrhea, OR in premenarchal girls, absence of menses at >15 years), and (ii) 27 EM aged 14-25 years. Participants completed the Beck Depression Inventory-II (BDI-II), State and Trait Anxiety Inventory (STAI), and Mood and Anxiety Symptoms Questionnaire (MASQ). Structural MRI and brain activation during a functional MRI (fMRI) task that probes reward and punishment processing was examined in a subset of 10 AA and 23 EM.
Median (IQR) age and BMI of AA and EM groups were 20.6 (19.0-22.6) vs. 20.6 (19.2-23.7) years, p=0.6 and v 20.3 (18.8-21.5) vs. 21.9 (19.6-23.5) kg/m2, p=0.005, respectively. While groups did not differ for BDI-II scores, AA had higher anhedonic depression MASQ scores (p=0.04), and STAI (p=0.03) scores vs. EM. In the fMRI subset, AA had higher caudate volumes vs. EM [F(1, 29)=9.930, p=0.004]. Lower activation observed in the right caudate during reward anticipation in AA compared with EM (p=0.036) suggests blunted reward processing in the striatum in estrogen deficient states.
Athletes with amenorrhea had higher depressive and anxiety symptomatology compared to eumenorrheic young women. Exploratory analyses demonstrated increased caudate volumes and decreased caudate activation during reward processing in athletes with amenorrhea suggesting that estrogen may play a role in reward processing.
在原发性卵巢功能不全和特纳综合征等雌激素缺乏状态的研究表明，雌激素状态可能是情绪和情感的重要调节剂。在这项研究中，我们比较了青春期和年轻成年女性低促性腺激素性闭经运动员（AA）和月经正常女性（EM）之间的抑郁和焦虑症状，并探讨了相关脑区在奖励处理过程中的结构和功能变化，这是抑郁和焦虑改变的一种行为结构。
我们纳入了（i）24 名 AA，她们每周至少进行 4 小时的有氧运动或跑步 20 英里/周，持续至少 6 个月，在过去的 6 个月内至少有 3 个月无月经周期，或在初潮前的女孩中，15 岁以上无月经），以及（ii）27 名 EM，年龄在 14-25 岁之间。参与者完成贝克抑郁量表第二版（BDI-II）、状态和特质焦虑量表（STAI）和情绪和焦虑症状问卷（MASQ）。在一组 10 名 AA 和 23 名 EM 中，检查了结构 MRI 和功能 MRI（fMRI）任务期间的大脑激活情况，该任务探测奖励和惩罚处理。
AA 和 EM 组的中位数（IQR）年龄和 BMI 分别为 20.6（19.0-22.6）与 20.6（19.2-23.7）岁，p=0.6 和 v 20.3（18.8-21.5）与 21.9（19.6-23.5）kg/m2，p=0.005。尽管两组的 BDI-II 评分无差异，但 AA 的快感缺失性抑郁 MASQ 评分（p=0.04）和 STAI（p=0.03）评分均高于 EM。在 fMRI 子集中，AA 的尾状核体积高于 EM [F（1，29）=9.930，p=0.004]。与 EM 相比，AA 右尾状核在奖励预期期间的激活降低（p=0.036），提示雌激素缺乏状态下纹状体的奖励处理能力下降。
与月经正常的年轻女性相比，闭经运动员的抑郁和焦虑症状更为严重。探索性分析表明，闭经运动员在奖励处理过程中尾状核体积增加，激活减少，提示雌激素可能在奖励处理中发挥作用。
