Department of Reproductive Medicine and Child Development, Division of Gynaecology and Obstetrics, University of Pisa, Pisa, Italy.
Menopause. 2010 Mar;17(2):338-43. doi: 10.1097/gme.0b013e3181c29e44.
Menopause is marked by a decline in ovarian function resulting in one or more climacteric symptoms. In the last few years, attention has been focused on the use of selective serotonin reuptake inhibitors (SSRIs) in the treatment of vasomotor symptoms associated with the menopausal transition. Thanks to the recent findings on the interaction between the serotoninergic system and neurotrophins, it has been suggested that brain-derived neurotrophic factor (BDNF) could contribute to the activity of SSRIs. Moreover, because endogenous gonadal hormones modulate both BDNF expression and serotonin biosynthesis and bioavailability and regulate brain functions like affective and cognitive functions, we proposed to evaluate the effects of a treatment with paroxetine, an SSRI, in a group of postmenopausal women and to clarify the possible relationship between paroxetine, plasma BDNF levels, and climacteric symptoms.
A total of 119 postmenopausal women (age, 46-60 y; menopause age, 1-20 y) were included; 89 took paroxetine 10 mg/day for 6 months and 30 took estrogen + progestogen therapy (EPT) for 6 months. Blood samples were taken before the beginning of the therapy and at 3 and 6 months. The Green Climacteric Scale questionnaire was used to follow up women's clinical conditions.
Plasma BDNF levels significantly increased after 3 and 6 months of therapy (P < 0.001), although a negative correlation between plasma BDNF level and both age and menopause age persisted throughout the treatment. Moreover, a significant reduction in the Greene Climacteric Scale score was observed. In the EPT group, the plasma BDNF level significantly increased after 6 months of therapy. The plasma BDNF levels after 6 months of paroxetine were significantly lower than those after 6 months of EPT.
The present data suggest that a low dose of paroxetine is effective in enhancing plasma BDNF levels, and this increase might have a role in improving climacteric symptoms, highlighting the possible role of BDNF in endocrinological and cognitive functions.
绝经以卵巢功能下降为标志，导致出现一种或多种绝经期症状。在过去的几年中，人们关注的焦点是选择性 5-羟色胺再摄取抑制剂（SSRIs）在治疗与绝经过渡相关的血管舒缩症状中的应用。由于最近发现了 5-羟色胺能系统与神经营养因子之间的相互作用，有人认为脑源性神经营养因子（BDNF）可能有助于 SSRIs 的活性。此外，由于内源性性腺激素调节 BDNF 的表达和 5-羟色胺的生物合成和生物利用度，并调节情感和认知等大脑功能，我们提出评估一组绝经后妇女服用帕罗西汀（SSRIs）的治疗效果，并阐明帕罗西汀、血浆 BDNF 水平和绝经期症状之间可能存在的关系。
共纳入 119 名绝经后妇女（年龄 46-60 岁；绝经年龄 1-20 岁）；89 名妇女服用帕罗西汀 10mg/天，治疗 6 个月；30 名妇女服用雌激素+孕激素治疗（EPT），治疗 6 个月。在治疗开始前和治疗 3 个月和 6 个月时采集血样。采用 Green 绝经期量表问卷随访女性的临床情况。
治疗 3 个月和 6 个月后，血浆 BDNF 水平显著升高（P<0.001），尽管治疗过程中血浆 BDNF 水平与年龄和绝经年龄呈负相关。此外，观察到 Greene 绝经期量表评分显著降低。在 EPT 组，治疗 6 个月后血浆 BDNF 水平显著升高。治疗 6 个月后帕罗西汀组的血浆 BDNF 水平明显低于 EPT 组。
本研究数据表明，低剂量帕罗西汀可有效提高血浆 BDNF 水平，这种增加可能在改善绝经期症状方面发挥作用，突出了 BDNF 在内分泌和认知功能中的可能作用。
