Shivakumar Geetha, Bernstein Ira H, Suppes Trisha, Keck Paul E, McElroy Susan L, Altshuler Lori L, Frye Mark A, Nolen Willem A, Kupka Ralph W, Grunze Heinze, Leverich Gabriele S, Mintz Jim, Post Robert M
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9086, USA.
J Womens Health (Larchmt). 2008 Apr;17(3):473-8. doi: 10.1089/jwh.2007.0466.
Evidence suggests gender differences may exist in bipolar disorder, and a review of the literature shows that more women than men may experience rapid-cycling bipolar disorder. The issues contributing to these gender differences are unknown; a number of case reports have indicated the possibility of mood changes secondary to hormonal influences during the menstrual cycle. We sought to examine the relationship between bipolar disorder and menstrual cycle-related mood changes. To our knowledge, this is one of the largest samples in the literature addressing this issue.
Outpatient women with bipolar disorder I, bipolar disorder II, and not otherwise specified (NOS), between the ages of 18 and 45, were evaluated. The National Institute of Mental Health Life Chart Method-p (NIMH-LCM-p) was used for daily mood ratings of depression and mania. Repeated measures of ANOVA and t tests were conducted separately for depressive and for manic symptom scores.
One hundred nineteen women met the age criterion, and only 41 women met the rest of the inclusion criteria. In this sample of 41 women, there was no significant relationship between phases of the menstrual cycle (early and late follicular and early and late luteal phases) and changes in depression or mania. In an exploratory examination, 8 of 41 women showed a numerically higher mean depression score in the luteal phase than in the follicular phase; 5 of 41 women showed a numerically higher mean mania score in the luteal phase than in the follicular phase of the menstrual cycle.
Different phases of the menstrual cycle were unrelated to depression and mania in a heterogeneous group of women with bipolar disorder. Prospective studies are needed to identify a vulnerable subpopulation in a homogeneous clinical sample.
有证据表明双相情感障碍可能存在性别差异，文献综述显示，经历快速循环型双相情感障碍的女性多于男性。导致这些性别差异的原因尚不清楚；一些病例报告指出，月经周期中激素影响可能导致情绪变化。我们试图研究双相情感障碍与月经周期相关情绪变化之间的关系。据我们所知，这是文献中针对该问题的最大样本之一。
对年龄在18至45岁之间、患有I型双相情感障碍、II型双相情感障碍及未特定指明型（NOS）的门诊女性进行评估。采用美国国立精神卫生研究所生活图表法-p（NIMH-LCM-p）对抑郁和躁狂进行每日情绪评分。分别对抑郁症状评分和躁狂症状评分进行重复测量方差分析和t检验。
119名女性符合年龄标准，只有41名女性符合其他纳入标准。在这41名女性样本中，月经周期各阶段（卵泡期早期和晚期、黄体期早期和晚期）与抑郁或躁狂变化之间无显著关系。在一项探索性检查中，41名女性中有8名在黄体期的平均抑郁评分在数值上高于卵泡期；41名女性中有5名在月经周期的黄体期的平均躁狂评分在数值上高于卵泡期。
月经周期的不同阶段与患有双相情感障碍的异质性女性群体中的抑郁和躁狂无关。需要进行前瞻性研究，以在同质临床样本中确定一个易患亚群。
