Rasgon Natalie L, Altshuler Lori L, Fairbanks Lynn A, Dunkin Jennifer J, Davtyan Camelia, Elman Shana, Rapkin Andrea J
Department of Psychiatry and Biobehavioral Science, University of California, Los Angeles, USA.
J Clin Psychiatry. 2002;63 Suppl 7:45-8.
Increased vulnerability to mood disorders has been reported during perimenopause. Fluctuating estrogen levels accompany the perimenopausal transition. Thus, estrogen replacement therapy (ERT) has been proposed as a potentially effective treatment for mood disorders occurring during perimenopause.
We examined the efficacy of ERT in the treatment of depression in 16 perimenopausal women with DSM-IV-defined major depressive disorder who were participating in the Mood Disorders Research Program at the Department of Psychiatry of the University of California, Los Angeles. Ten antidepressant- and ERT-naive women received ERT alone. Six women who were nonresponders or partial responders to an antidepressant received ERT in addition to existing treatment with fluoxetine. The Hamilton Rating Scale for Depression (HAM-D) was administered to all patients at baseline and weekly thereafter during the 8-week open-protocol trial. Partial response was operationalized as a final HAM-D score < or = 50% of the baseline score. Remission was defined as a final HAM-D score < or = 7.
All patients exhibited clinical improvement as measured by HAM-D scores after the first week of treatment. Of the 10 perimenopausal depressed women receiving ERT alone, 6 remitted, 3 partially responded to treatment, and 1 did not respond by the end of the trial. Of the 6 women receiving antidepressant treatment with ERT, 1 patient remitted and 5 had a partial response by the end of the trial.
This small study suggests that for some antidepressant-naive perimenopausal women with clinical depression, ERT may have antidepressant efficacy. In depressed women who have minimal response to a selective serotonin reuptake inhibitor, ERT may augment response. Further controlled trials are needed.
围绝经期期间情绪障碍的易感性增加已有报道。围绝经期过渡伴随着雌激素水平的波动。因此，雌激素替代疗法（ERT）已被提议作为围绝经期发生的情绪障碍的一种潜在有效治疗方法。
我们在加利福尼亚大学洛杉矶分校精神病学系的情绪障碍研究项目中，研究了ERT对16名患有DSM-IV定义的重度抑郁症的围绝经期女性抑郁症治疗的疗效。10名未使用过抗抑郁药和ERT的女性仅接受ERT治疗。6名对抗抑郁药无反应或部分反应的女性在接受氟西汀现有治疗的基础上还接受了ERT治疗。在为期8周的开放试验中，在基线时对所有患者进行汉密尔顿抑郁量表（HAM-D）评定，此后每周评定一次。部分反应定义为最终HAM-D评分≤基线评分的50%。缓解定义为最终HAM-D评分≤7。
治疗第一周后，所有患者的HAM-D评分均显示临床改善。在仅接受ERT治疗的10名围绝经期抑郁症女性中，6名缓解，3名对治疗部分反应，1名在试验结束时无反应。在接受ERT联合抗抑郁药治疗的6名女性中，1名患者缓解，5名在试验结束时部分反应。
这项小型研究表明，对于一些未使用过抗抑郁药的围绝经期临床抑郁症女性，ERT可能具有抗抑郁疗效。在对选择性5-羟色胺再摄取抑制剂反应最小的抑郁症女性中，ERT可能增强反应。需要进一步的对照试验。
