Freeman Ellen W, Sondheimer Steven J, Sammel Mary D, Ferdousi Tahmina, Lin Hui
Department of Obstetrics and Gynecology, University of Pennsylvania Medical Center, Philadelphia, 19104, USA.
J Clin Psychiatry. 2005 Jun;66(6):769-73. doi: 10.4088/jcp.v66n0616.
This preliminary study compared the efficacy and tolerability of escitalopram administered at symptom onset or throughout the luteal phase in premenstrual dysphoric disorder (PMDD).
Twenty-seven women meeting DSM-IV criteria for PMDD were randomly assigned in a double-blind manner to luteal phase (N = 13) or symptom-onset (N = 14) dosing of escitalopram (10-20 mg/day) for 3 consecutive menstrual cycles. Participants were enrolled from November 2002 to July 2003, and data collection was completed in December 2003. Symptoms were assessed using the 17-item Penn Daily Symptom Report (DSR), the Clinical Global Impressions-Improvement scale, the Hamilton Rating Scale for Depression, and the Sheehan Disability Scale. Scores were compared using repeated measures analysis of covariance and t statistics.
Luteal phase and symptom-onset groups received escitalopram for a mean of 13.5 and 6.0 days, respectively (mean +/- SD dose = 15.2 +/- 5.1 mg/day at the third treatment cycle). Total premenstrual DSR scores significantly improved from baseline (p = .003), with a 57% decrease in the luteal phase group and a 51% decrease in the symptom-onset group. Clinical improvement (DSR score decrease > or = 50% from baseline) was reported by 11 of 13 patients in the luteal phase group and 9 of 14 patients in the symptom-onset group. Symptom severity differentiated the response in the symptom-onset group, with those having more severe symptoms less likely to respond. Symptom severity did not differentiate treatment response to luteal phase dosing. Escitalopram was well tolerated. Adverse events were mild and transient, with only 2 patients discontinuing due to adverse events related to the medication.
Premenstrual dysphoric disorder improved significantly with either luteal phase or symptom-onset dosing of escitalopram. Women with more severe PMDD may respond better to luteal phase dosing than symptom-onset dosing.
本初步研究比较了在经前烦躁障碍（PMDD）症状发作时或整个黄体期服用艾司西酞普兰的疗效和耐受性。
27名符合PMDD的DSM-IV标准的女性以双盲方式随机分配至黄体期组（N = 13）或症状发作期组（N = 14），服用艾司西酞普兰（10 - 20毫克/天），连续3个月经周期。参与者于2002年11月至2003年7月入组，数据收集于2003年12月完成。使用17项宾夕法尼亚每日症状报告（DSR）、临床总体印象改善量表、汉密尔顿抑郁评定量表和希恩残疾量表评估症状。使用重复测量协方差分析和t统计量比较得分。
黄体期组和症状发作期组接受艾司西酞普兰治疗的平均天数分别为13.5天和6.0天（第三个治疗周期的平均±标准差剂量 = 15.2±5.1毫克/天）。经前DSR总分较基线显著改善（p = 0.003），黄体期组下降57%，症状发作期组下降51%。黄体期组13名患者中有11名、症状发作期组14名患者中有9名报告临床改善（DSR评分较基线下降≥50%）。症状严重程度在症状发作期组中区分了反应，症状较严重的患者反应的可能性较小。症状严重程度在黄体期给药的治疗反应中未起到区分作用。艾司西酞普兰耐受性良好。不良事件轻微且短暂，仅有2名患者因与药物相关的不良事件而停药。
无论是在黄体期还是症状发作期服用艾司西酞普兰，经前烦躁障碍均有显著改善。PMDD较严重的女性可能对黄体期给药的反应比对症状发作期给药的反应更好。
