Landén Mikael, Nissbrandt Hans, Allgulander Christer, Sörvik Karin, Ysander Christina, Eriksson Elias
Department of Clinical Neuroscience, Section of Psychiatry St Göran, Karolinska Institutet, Stockholm, Sweden.
Neuropsychopharmacology. 2007 Jan;32(1):153-61. doi: 10.1038/sj.npp.1301216. Epub 2006 Oct 11.
Serotonin reuptake inhibitors (SRIs) do not have to be administered continuously to be effective for premenstrual dysphoric disorder (PMDD), but can be given during luteal phases only. This is of practical importance, but also of theoretical interest since it suggests that the onset of action of SRIs is shorter in PMDD than in, for example depression. In this study, both continuous and intermittent SRI administration was compared with placebo, with the special purpose of analyzing if different PMDD symptoms respond differently depending on the treatment regimen. To this end, women meeting slightly modified DSM-IV criteria for PMDD (mean+/-SD age, 37+/-6.3 years) were treated for three menstrual cycles with paroxetine continuously, paroxetine during the luteal phase only, or placebo, the population completing at least one treatment cycle comprising 55-56 subjects per group. Continuous treatment with paroxetine reduced premenstrual symptoms effectively with a response rate of 85%. The effect size was highest for irritability (1.4) and lowest for lack of energy (0.5). Intermittent treatment was as effective as continuous treatment in reducing irritability, affect lability, and mood swings, but had a somewhat weaker effect on depressed mood and somatic symptoms. The study indicates that the response rate when treating PMDD with SRIs is high, and that irritability is a key target symptom. Symptoms such as irritability, affect lability, and mood swings appear to be more inclined to respond rapidly to SRIs, enabling intermittent treatment, than are, for example, the somatic symptoms.
血清素再摄取抑制剂（SRIs）治疗经前烦躁障碍（PMDD）并不需要持续给药才有效，仅在黄体期给药即可。这具有实际重要性，也具有理论意义，因为这表明SRIs在PMDD中的起效时间比在例如抑郁症中更短。在本研究中，将SRIs持续给药和间歇给药与安慰剂进行了比较，特别目的是分析不同的PMDD症状是否根据治疗方案而有不同反应。为此，符合稍微修改后的PMDD DSM-IV标准（平均±标准差年龄，37±6.3岁）的女性接受了三个月经周期的治疗，分别是持续服用帕罗西汀、仅在黄体期服用帕罗西汀或服用安慰剂，每组完成至少一个治疗周期的人群包括55 - 56名受试者。持续服用帕罗西汀有效减轻了经前症状，有效率为85%。易怒症状的效应量最高（1.4），精力不足症状的效应量最低（0.5）。间歇治疗在减轻易怒、情绪不稳定和情绪波动方面与持续治疗效果相同，但对抑郁情绪和躯体症状的效果稍弱。该研究表明，用SRIs治疗PMDD时有效率很高，且易怒是关键的目标症状。与例如躯体症状相比，易怒、情绪不稳定和情绪波动等症状似乎更倾向于对SRIs迅速产生反应，从而允许间歇治疗。
