Yonkers Kimberly A, Holthausen Gretchen A, Poschman Karalee, Howell Heather B
Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA.
J Clin Psychopharmacol. 2006 Apr;26(2):198-202. doi: 10.1097/01.jcp.0000203197.03829.ae.
Symptoms of premenstrual dysphoric disorder (PMDD) respond to serotonin reuptake inhibitors when treatment is limited to 14 days of the menstrual cycle. Many women have less than a week of symptoms, and shorter treatment intervals would further reduce medication exposure and costs.
Twenty women with PMDD were randomly assigned to either paroxetine CR or placebo for 1 cycle and crossed over to the other condition for a second cycle. Subjects initiated treatment when premenstrual symptoms began and stopped within 3 days of beginning menses.
Women took capsules for an average of 9 days (range, 3-15 days), including the first few days of menses. Moderate "PMDD level" symptoms occurred in 1 subject (6%) for 2 days and 4 subjects (24%) for 1 day before starting paroxetine or placebo. Daily Record of Severity of Problems scores were lower in the paroxetine group compared with the placebo group, although the differences were not statistically significant. However, the mean on-treatment Inventory of Depressive Symptomatology (clinician-rated) score for the paroxetine group was 17.9 +/- 8.3 compared with 31.5 +/- 11.2 in the placebo group (adjusted mean difference = 13.6, P = 0.009). Response (Clinical Global Impressions Scale score of 1 or 2) occurred in 70% of subjects randomized to paroxetine CR and 10% of those assigned to placebo (chi2(1) = 7.5, P = 0.006). Discontinuation symptoms did not differ in the groups.
These data suggest the need to further evaluate symptom-onset treatment in a larger randomized clinical trial.
经前烦躁障碍（PMDD）的症状在月经周期仅治疗14天时对5-羟色胺再摄取抑制剂有反应。许多女性的症状持续不到一周，更短的治疗间隔将进一步减少药物暴露和成本。
20名患有PMDD的女性被随机分配接受帕罗西汀控释片或安慰剂治疗1个周期，然后交叉接受另一种治疗2个周期。受试者在经前症状开始时开始治疗，并在月经开始后3天内停止治疗。
女性平均服用胶囊9天（范围为3-15天），包括月经的头几天。在开始服用帕罗西汀或安慰剂之前，1名受试者（6%）出现中度“PMDD水平”症状持续2天，4名受试者（24%）出现1天。与安慰剂组相比，帕罗西汀组的每日问题严重程度记录得分较低，尽管差异无统计学意义。然而，帕罗西汀组的平均治疗期抑郁症状量表（医生评定）评分为17.9±8.3，而安慰剂组为31.5±11.2（调整后平均差异=13.6，P=0.009）。随机接受帕罗西汀控释片治疗的受试者中有70%有反应（临床总体印象量表评分为1或2），而接受安慰剂治疗的受试者中这一比例为10%（χ2(1)=7.5，P=0.006）。两组的停药症状无差异。
这些数据表明需要在更大规模的随机临床试验中进一步评估症状发作时的治疗。
