Department of Psychology, University of Gothenburg, Sweden.
Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Sweden.
J Affect Disord. 2025 Jan 15;369:599-607. doi: 10.1016/j.jad.2024.10.020. Epub 2024 Oct 10.
Selective serotonin reuptake inhibitors (SSRI) are the primary treatment for premenstrual mood symptoms and particularly effective in reducing reactive aggression in the forms of irritability and anger. The present study examined whether behavioral responses in laboratory measures of reactive aggression are influenced by medication with the SSRI escitalopram in women reporting high levels of premenstrual irritability/anger.
Participants (N = 34) rated the cardinal mood symptoms of premenstrual dysphoric disorder over three menstrual cycles. During the second and third cycles, participants received escitalopram (20 mg) or placebo in a single-blind, cross-over design. In the luteal phase of the intervention cycles, participants completed two aggression tasks: The Anger-Infused Ultimatum Game (AI-UG) and the Point Subtraction Aggression Paradigm (PSAP). Additionally, they rated expression and control of anger using the State-Trait Anger Expression Inventory-2 (STAXI-2) once in the luteal phase and once in the follicular phase.
While irritability/anger was reduced in the treatment (vs. placebo) cycle, no effect of escitalopram was detected in the PSAP. Escitalopram decreased reactive aggressive behavior in the AI-UG but only for a subset of participants who experienced a sharp premenstrual rise in outwardly expressed anger and/or did not experience a premenstrual rise in inwardly expressed anger.
The participants' symptoms were based on the severity of only premenstrual irritability/anger, limiting the generalizability to the broader group of PMDD patients.
The results suggest that the behavioral consequences of severe premenstrual irritability/anger are not easily captured by traditional measures of reactive aggression and underline the importance of considering individual differences in symptom expression.
选择性 5-羟色胺再摄取抑制剂（SSRIs）是治疗经前情绪症状的主要药物，尤其能有效减少易激惹和愤怒等形式的反应性攻击行为。本研究旨在探讨在报告经前易激惹/愤怒症状严重的女性中，SSRI 艾司西酞普兰的药物治疗是否会影响实验室反应性攻击行为测量的行为反应。
参与者（N=34）在三个月经周期中对经前心境恶劣障碍的主要症状进行评分。在第二和第三个周期中，参与者以单盲、交叉设计的方式接受艾司西酞普兰（20mg）或安慰剂治疗。在干预周期的黄体期，参与者完成了两项攻击任务：愤怒注入最后通牒游戏（AI-UG）和点数减法攻击范式（PSAP）。此外，他们在黄体期和卵泡期各进行一次使用状态特质愤怒表达量表-2（STAXI-2）对内向外表达愤怒的控制和表达进行评分。
尽管在治疗（与安慰剂相比）周期中易激惹/愤怒有所减轻，但艾司西酞普兰在 PSAP 中没有效果。艾司西酞普兰降低了 AI-UG 中的反应性攻击行为，但仅对一部分经历了明显的经前外向表达愤怒升高和/或没有经历经前内向表达愤怒升高的参与者有效。
参与者的症状仅基于经前易激惹/愤怒的严重程度，限制了对更广泛的 PMDD 患者群体的推广。
结果表明，严重经前易激惹/愤怒的行为后果不易被传统的反应性攻击行为测量所捕捉，强调了考虑症状表达个体差异的重要性。
