Klier Claudia M, Muzik Maria, Dervic Kanita, Mossaheb Nilufar, Benesch Thomas, Ulm Barbara, Zeller Maria
Department of Child and Adolescent Neuropsychiatry, Medical University of Vienna, Waehringerguertel 18-20, 1090 Vienna, Austria.
J Psychiatr Res. 2007 Apr-Jun;41(3-4):273-9. doi: 10.1016/j.jpsychires.2006.09.002. Epub 2006 Oct 17.
Previous reports suggest that massive hormonal changes that accompany the peripartum period may trigger perinatal depression. We investigated the relationship between magnitude of change and total level of estrogen and progesterone and grade of peripartal depression and depressive symptoms. One hundred and ninety two women were assessed in the 38th week of pregnancy (SDS scores), peripartum period (DSM-III-R diagnosis (n=105); SDS scores) and 6 months postpartum (EPDS; n=89) regarding diagnosis of depression, self-ratings of depressive symptoms and levels of estrogen and progesterone. The comparison of three diagnostic groups (lifetime major depressive disorder MDD (N=7), MDD at birth (N=12), healthy controls (N=70) showed that there were no differences in the magnitude of decline of estrogen and progesterone from day 1 to day 3 after birth . With respect to total levels of estrogen and progesterone, estrogen on day 3 was significantly higher [F(2,92)=6.6, p<0.05] in women with current MDD than in those with lifetime MDD or normal controls. Depression scores were significantly higher at the end of pregnancy (12.6% self-identified as depressed) than in postpartum period (5.8% day 3 p<.0004; 9.2% day 5 p<.008), whereas 13.3% of women received a DSM-III -R diagnosis for MDD 5 days postpartum. The results were in contrast to the current hypotheses of estrogen withdrawal or hypogonadal levels as an etiological factor for peripartum depression. But a limitation of the actual study is the low number of subjects with depression; therefore the current non-significant findings should be interpreted with great caution.
先前的报告表明，围产期伴随的大量激素变化可能引发围产期抑郁症。我们研究了雌激素和孕激素变化幅度及总量与围产期抑郁症程度和抑郁症状之间的关系。对192名女性在妊娠第38周（抑郁自评量表[SDS]评分）、围产期（精神疾病诊断与统计手册第三版修订版[DSM-III-R]诊断，n = 105；SDS评分）及产后6个月（爱丁堡产后抑郁量表[EPDS]；n = 89）进行了评估，内容包括抑郁症诊断、抑郁症状自评以及雌激素和孕激素水平。对三个诊断组（终生性重度抑郁症[MDD]，N = 7；分娩时患MDD，N = 12；健康对照，N = 70）的比较显示，出生后第1天至第3天雌激素和孕激素下降幅度无差异。就雌激素和孕激素总量而言，当前患MDD的女性产后第3天的雌激素水平显著更高[F(2,92)=6.6，p<0.05]，高于终生性MDD患者或正常对照。妊娠末期的抑郁评分显著高于产后（妊娠末期12.6%自述抑郁；产后第3天5.8%，p<0.0004；产后第5天9.2%，p<0.008），而13.3%的女性在产后5天被DSM-III-R诊断为MDD。这些结果与当前关于雌激素撤退或性腺功能减退水平是围产期抑郁症病因的假说相反。但本研究的一个局限是抑郁症患者数量较少；因此，当前这些无显著差异的结果应极为谨慎地解读。
