Kornstein S G, Harvey A T, Rush A J, Wisniewski S R, Trivedi M H, Svikis D S, McKenzie N D, Bryan C, Harley R
Department of Psychiatry, Virginia Commonwealth University, Richmond, VA 23298, USA.
Psychol Med. 2005 May;35(5):683-92. doi: 10.1017/s0033291704004106.
Very little research has examined the frequency with which women with major depressive disorder experience premenstrual exacerbation (PME) of depression or the characteristics of those who report such worsening. The NIMH Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study provides a unique opportunity to evaluate PME in depressed women seeking treatment in primary care or psychiatric settings.
This report presents data from the first 1500 participants enrolled in the STAR*D study. Premenopausal women with major depressive disorder were asked if they experienced a worsening of their depressive symptoms 5-10 days prior to menses. Those reporting PME were compared with those reporting no PME with regard to sociodemographic characteristics, course of illness features, symptom presentation, general medical co-morbidity, functional impairment, and quality of life.
Of 433 premenopausal women not taking oral contraceptives, 64% reported a premenstrual worsening of their depression. Women who reported PME had a longer duration of their current major depressive episode [30.7 (S.D. = 73.7) months versus 13.5 (S.D. = 13.2) months; p=0.001], as well as greater general medical co-morbidity. Women reporting PME were also more likely to endorse symptoms of leaden paralysis, somatic complaints, gastrointestinal complaints, and psychomotor slowing, and were less likely to endorse blunted mood reactivity.
PME is endorsed by the majority of premenopausal women with major depressive disorder and appears to be associated with a longer duration of depressive episode. PME is a common and important clinical issue deserving of further attention in both research and practice.
极少有研究探讨重度抑郁症女性经历经前抑郁加重（PME）的频率，或报告此类病情恶化的女性的特征。美国国立精神卫生研究所的缓解抑郁症序列治疗方案（STAR*D）研究提供了一个独特的机会，来评估在初级保健或精神科环境中寻求治疗的抑郁症女性的PME情况。
本报告呈现了STAR*D研究中首批1500名参与者的数据。患有重度抑郁症的绝经前女性被问及在月经前5 - 10天抑郁症状是否加重。将报告有PME的女性与报告无PME的女性在社会人口学特征、病程特征、症状表现、一般医疗合并症、功能损害和生活质量等方面进行比较。
在433名未服用口服避孕药的绝经前女性中，64%报告经前抑郁加重。报告有PME的女性当前重度抑郁发作的持续时间更长[30.7（标准差 = 73.7）个月对13.5（标准差 = 13.2）个月；p = 0.001]，且一般医疗合并症更多。报告有PME的女性也更有可能认可铅样麻痹、躯体不适、胃肠道不适和精神运动迟缓等症状，而不太可能认可情绪反应迟钝。
大多数患有重度抑郁症的绝经前女性认可PME情况，且似乎与抑郁发作持续时间较长有关。PME是一个常见且重要的临床问题，在研究和实践中都值得进一步关注。
