Stiernman Louise, Dubol Manon, Comasco Erika, Johansson Maja, Stiernman Lars, Bixo Marie
Department of Clinical Sciences, Umeå University, Umeå, Sweden; Umeå Center for Functional Brain Imaging, Umeå University, Umeå, Sweden.
Department of Women's and Children's Health, Uppsala University, Science for Life Laboratory, Uppsala, Sweden.
Biol Psychiatry. 2025 Jun 6. doi: 10.1016/j.biopsych.2025.05.025.
Emotion regulation deficits have been highlighted as a transdiagnostic feature of multiple psychiatric disorders, including premenstrual dysphoric disorder (PMDD). In this study, we hypothesized that deficient prefrontal top-down regulation of key nodes of the salience network (SN) is a characteristic of PMDD, driven by increased levels of progesterone-derived neuroactive steroids.
Functional magnetic resonance imaging was used to investigate menstrual cycle-related variations in brain activity and connectivity during 2 emotional tasks (emotion generation and regulation) in 29 women with PMDD and 27 control women. We also examined whether differential brain activation between groups was related to serum levels of progesterone-derived neuroactive steroids and premenstrual symptom severity.
Women with PMDD showed increased reactivity in key nodes of the SN and, at subthreshold level, in the default mode network during the luteal phase when passively viewing negative emotional stimuli. Intriguingly, SN hyperactivity in patients with PMDD was also apparent during the follicular phase and related to premenstrual symptom severity. Women with PMDD and control women had similar network connectivity patterns and activity in regions associated with the conscious control of emotion in PMDD. No link to progesterone-derived neuroactive steroids was found.
Multiple network aberrations during the luteal phase may explain the development of mood symptoms during the luteal phase. Furthermore, higher baseline (follicular) SN activity may render women with PMDD more susceptible to severe mood symptoms in response to hormonal fluctuations. What drives increased SN activity in the follicular phase is unknown, but innate and neuroplastic mechanisms have been proposed.
情绪调节缺陷已被视为多种精神疾病的一种跨诊断特征，包括经前烦躁障碍（PMDD）。在本研究中，我们假设前额叶对突显网络（SN）关键节点的自上而下调节不足是PMDD的一个特征，这是由孕酮衍生的神经活性类固醇水平升高所驱动的。
采用功能磁共振成像来研究29名患有PMDD的女性和27名对照女性在两项情绪任务（情绪产生和调节）过程中与月经周期相关的大脑活动和连通性变化。我们还检查了两组之间的脑激活差异是否与孕酮衍生的神经活性类固醇的血清水平和经前症状严重程度有关。
患有PMDD的女性在黄体期被动观看负面情绪刺激时，突显网络的关键节点反应性增加，并且在阈下水平时，默认模式网络的反应性也增加。有趣的是，PMDD患者的突显网络活动亢进在卵泡期也很明显，并且与经前症状严重程度有关。患有PMDD的女性和对照女性在与PMDD中情绪的有意识控制相关的区域具有相似的网络连通性模式和活动。未发现与孕酮衍生的神经活性类固醇有联系。
黄体期的多种网络异常可能解释了黄体期情绪症状的出现。此外，较高的基线（卵泡期）突显网络活动可能使患有PMDD的女性更容易因激素波动而出现严重的情绪症状。卵泡期突显网络活动增加的驱动因素尚不清楚，但已提出了先天性和神经可塑性机制。
