***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE The authors sought to determine whether the administration of flumazenil would induce marked panic symptoms in women suffering from premenstrual dysphoric disorder . METHOD Ten women with premenstrual dysphoric disorder and 11 comparison subjects were injected with flumazenil or placebo in a double-blind , r and omized , balanced crossover design in a single session in the luteal phase of their menstrual cycles . RESULTS Flumazenil induced a much greater panic response in the women with premenstrual dysphoric disorder than in the comparison subjects . CONCLUSIONS These preliminary results are consistent with a dysregulation of the g-aminobutyric acid A/benzodiazepine receptor complex during the premenstruum of women suffering from premenstrual dysphoric disorder BACKGROUND We assessed associations of mood at 5 - 6 weeks postpartum with peripartum saliva cortisol and progesterone profiles . METHOD A prospect i ve study involved 120 primiparous women free of major marital , socioeconomic and health problems , who collected saliva twice daily  from 2 weeks before delivery to day 35 postpartum . This allowed intensive characterisation of cortisol and progesterone profiles . At the conclusion of the study , mood was assessed according to st and ard criteria . RESULTS Seven women developed major depression according to DSM-III-R criteria . No associations emerged between progesterone and mood at 5 to 6 weeks . Lower levels of evening cortisol in the immediate peripartum period , were associated with postnatal depression . CONCLUSION The study provides no support for the treatment strategy of progesterone augmentation following delivery , as a prophylactic against postnatal depression . The HPA axis and its associations with postnatal mood warrants further investigation IMPORTANCE An increased risk of depressive symptoms has been associated with the transition to menopause , but the risk of depressive symptoms in the early postmenopausal years has not been well characterized . OBJECTIVES To identify within-woman changes in depressive symptoms during a 14-year period around menopause , determine associations of a history of depression with the pattern of depressive symptoms , and evaluate the rate of change in reproductive hormones as predictors of depressive symptoms following menopause . DESIGN , SETTING , AND PARTICIPANTS A r and omly identified , population -based sample in Philadelphia County , Pennsylvania , of 203 late-reproductive-age women who were premenopausal at baseline and reached natural menopause . MAIN OUTCOMES AND MEASURES Center for Epidemiologic Studies Depression Scale . RESULTS The prevalence of high scores on the Center for Epidemiologic Studies Depression Scale decreased from 10 years before to 8 years after the final menstrual period ( FMP ) , with a decrease of approximately 15 % of baseline per year ( odds ratio , 0.85 ; 95 % CI , 0.81 - 0.89 ; P < .001 ) . Relative to the FMP , the risk of depressive symptoms was higher in the years before and lower in the years after the FMP . Among women with a history of depression , the likelihood of depressive symptoms was more than 13 times greater overall and 8 times greater after menopause compared with women with no depression history . Among women who first experienced depressive symptoms approaching menopause , the risk of depressive symptoms declined after the FMP , with a significantly lower risk the second year after menopause . The risk of depressive symptoms after menopause decreased by 35 % for each unit ( SD ) increase before the FMP in the log rate of change of follicle-stimulating hormone ( odds ratio , 0.65 ; 95 % CI , 0.46 - 0.91 ; P = .01 ) . CONCLUSIONS AND RELEVANCE The FMP was pivotal in the overall pattern of decreasing depressive symptoms in midlife women , with higher risk before and lower risk after the FMP . A history of depression strongly increased the risk both before and after menopause . Women who had no history of depression before the menopause transition had a low risk of depressive symptoms 2 or more years after the FMP Allopregnanolone is a neuroactive metabolite of progesterone and a barbiturate-like modulator of central γ-aminobutyric acidA receptors that modify a range of behaviors , including the stress response . The aim of this study was to determine the association of allopregnanolone levels with improvement of mood and behavioral symptoms following antidepressant treatment for severe premenstrual syndrome . A second exploratory aim was to determine whether allopregnanolone levels differed between antidepressant and placebo treatments . Serum sample s from 46 women who were treated with sertraline , desipramine , or placebo in double-blind conditions were assayed . Improvement was assessed as the percent change from the pretreatment baseline in premenstrual symptoms , which were rated daily by the subjects . Twenty-seven sample s were from improved subjects and 19 sample s were from unimproved subjects following 2 to 3 months of double-blind treatment . Posttreatment allopregnanolone levels were significantly lower in the improved compared with the unimproved subjects . Improvement was also significantly associated with lower allopregnanolone levels for premenstrual depression and appetite changes . Improvement remained significantly associated with lower allopregnanolone levels after adjustment for treatment , cycle day of blood draw , age , and the interaction of treatment and cycle day . These preliminary results offer the first placebo-controlled evidence of association between allopregnanolone levels and premenstrual syndrome treatment response and suggest the importance of further study of the associations of allopregnanolone with premenstrual syndromes and the role of allopregnanolone in response to antidepressant medications OBJECTIVE Endocrine factors are purported to play a role in the etiology of postpartum depression , but direct evidence for this role is lacking . The authors investigated the possible role of changes in gonadal steroid levels in postpartum depression by simulating two hormonal conditions related to pregnancy and parturition in euthymic women with and without a history of postpartum depression . METHOD The supraphysiologic gonadal steroid levels of pregnancy and withdrawal from these high levels to a hypogonadal state were simulated by inducing hypogonadism in euthymic women-eight with and eight without a history of postpartum depression-with the gonadotropin-releasing hormone agonist leuprolide acetate , adding back supraphysiologic doses of estradiol and progesterone for 8 weeks , and then withdrawing both steroids under double-blind conditions . Outcome measures were daily symptom self-ratings and st and ardized subjective and objective cross-sectional mood rating scales . RESULTS Five of the eight women with a history of postpartum depression ( 62.5 % ) and none of the eight women in the comparison group developed significant mood symptoms during the withdrawal period . Analysis of variance with repeated measures of daily and cross-sectional ratings of mood showed significant phase-by-group effects . These effects reflected significant increases in depressive symptoms in women with a history of postpartum depression but not in the comparison group after hormone withdrawal ( and during the end of the hormone replacement phase ) , compared with baseline . CONCLUSIONS The data provide direct evidence in support of the involvement of the reproductive hormones estrogen and progesterone in the development of postpartum depression in a subgroup of women . Further , they suggest that women with a history of postpartum depression are differentially sensitive to mood-destabilizing effects of gonadal steroids We have investigated the ability of citalopram , a serotonin reuptake inhibitor , to alter the functional sensitivity to a neuroactive steroid during the late luteal phase in twelve women with premenstrual syndrome . Sensitivity to pregnanolone was assessed by comparing the effect of three increasing doses of intravenous pregnanolone on saccadic eye velocity ( SEV ) and self-rated sedation . Testings were performed in two consecutive menstrual cycles ; without treatment and during citalopram treatment . During citalopram treatment , pregnanolone injections induced a significant SEV reduction compared to vehicle , whereas during the pre-treatment cycle there was no significant change in SEV response between vehicle and pregnanolone injections . Citalopram treatment did not alter the self-rated sedation response to pregnanolone compared to vehicle in either study cycle . These findings indicate that treatment with a selective serotonin reuptake inhibitor in the luteal phase increases the pregnanolone sensitivity in patients with premenstrual syndrome Postpartum depression ( PPD ) affects up to 19 % of all women after parturition . The non-apeptide oxytocin ( OXT ) is involved in adjustment to pregnancy , maternal behavior , and bonding . Our aim was to examine the possible association between plasma OXT during pregnancy and the development of PPD symptoms . A total of 74 healthy , pregnant women were included in this prospect i ve study . During the third trimester of pregnancy and within 2 weeks after parturition , PPD symptoms were assessed using the Edinburgh Postnatal Depression Scale ( EPDS ) . Blood sample s for  plasma OXT assessment were collected in the third trimester . Following the literature , participants with postpartum EPDS scores  of 10 or more were regarded as being at risk for PPD development ( rPPD group ) . In a logistic regression analysis , plasma OXT was included as a potential predictor for being at risk for PPD . Results were controlled for prepartal EPDS score , sociodemographic and birth- outcome variables . Plasma OXT concentration in mid-pregnancy significantly predicted PPD symptoms at 2 weeks postpartum . Compared with the no-risk-for-PPD group , the rPPD group was characterized by lower plasma OXT concentrations . To our knowledge , this is the first study to show an association between prepartal plasma OXT concentration and postpartal symptoms of PPD in humans . Assuming a causal relationship , enhancing OXT release during pregnancy could serve as a potential target in prepartum PPD prevention , and help to minimize adverse effects of PPD on the mother – child relationship BACKGROUND We sought to determine the prevalence of , and association between , reproductive cycle-associated mood symptoms in women with affective disorders . We hypothesized that symptoms would correlate with each other across a woman 's reproductive life span in both major depression ( MDD ) and bipolar I disorder ( BP ) . METHODS 2412 women with , MDD or BP were asked st and ardized questions about mood symptoms prior to menstruation , within a month of childbirth and during perimenopause .  Lifetime rates for each of these symptom types were determined and an odds ratio was calculated correlating each of the types with the others . RESULTS Of 2524 women with mood disorders , 67.7 % reported premenstrual symptoms . Of those at risk , 20.9 % reported postpartum symptoms and 26.4 % reported perimenopausal symptoms . The rates did not differ between women with MDD and BP but were significantly different from women who were never ill . The symptoms were significantly correlated in women with MDD with odds ratios from 1.66 to 1.82 , but were not in women with BP . LIMITATIONS This is a secondary analysis of a sample that was collected for other purpose s and is based upon retrospective reporting . CONCLUSIONS Reproductive cycle-associated mood symptoms were commonly reported in women with mood disorders and did not differ based on diagnosis . In MDD , but not BP , the occurrence of these symptoms was trait-like as the presence of one predicted the occurrence of the others . Further prospect i ve study is required to clarify the determinants of this trait Premenstrual syndrome ( PMS ) is characterized by cyclical changes in psychological and physical symptoms related to the formation of the corpus luteum and the fluctuations of gonadal hormones . Ovarian steroids have direct effects on neurotransmission , exemplified by the binding of certain metabolites of progesterone to the gamma-amino-butyric acid ( GABAA ) receptor where they exert a facilitating effect on inhibitory neurotransmission . There is also evidence for steroids with inverse-agonist actions on the GABAA-receptor with opposite effects on the GABAergic transmission . The purpose of this pilot study was to examine a possible decrease in GABAA/benzodiazepine-receptor sensitivity in PMS patients using saccadic eye velocity and self-ratings of sedation as dependent measures . Seven patients with proven PMS and seven control subjects were recruited for the study .  Saccadic eye velocity ( SEV ) and visual analogue ratings for sedation and mood were measured after increasing doses of placebo and diazepam . The PMS patients responded with a significantly less decrease in saccadic eye velocity after benzodiazepine injections compared with control subjects , the difference being most prominent in the luteal phase . This group difference was due to an increased SEV responsiveness to benzodiazepines among control subjects in the luteal phase compared with the follicular phase . The PMS patients in the luteal phase responded with less increase in sedation change scores following benzodiazepine injections compared with control subjects . This group difference in the luteal phase was due to a decreased sedation response to benzodiazepines across the menstrual cycle in the PMS patients . There was no correlation between sedation change scores and SEV in PMS patients . These results support evidence for a reduced or dysregulated sensitivity at the GABAA/ benzodiazepine-receptor complex in patients with PMS Plasma cortisol , prolactin , oestrogen , progesterone , thyroxine , thyrotrophin ( TSH ) were collected from 23 pregnant , 70 postpartum women at 7 days postpartum , and 38 non-gravid controls 
    Output:
    
GABA-inhibitory function was reduced in pregnancy and early postpartum compared to the nonpregnant state .
GABA-inhibitory function fluctuates across the menstrual cycle and is reduced perinatally .