Clayton Anita H, Ninan Philip T
University of Virginia, Charlottesville, and Pfizer Inc, formerly Wyeth Research, Collegeville, Pennsylvania.
Prim Care Companion J Clin Psychiatry. 2010;12(1):PCC.08r00747. doi: 10.4088/PCC.08r00747blu.
The purpose of this review was to examine the risk of depression onset in perimenopausal and postmenopausal women, discuss the importance and rationale for screening for major depressive disorder (MDD) in women in the menopausal transition, and review therapeutic options for management of MDD in perimenopausal and postmenopausal women.
PubMed was searched (1970 to 2008) using combinations of the following terms: major depressive disorder, perimenopause, postmenopause, mood disorder, risk factors, reproductive period, family practice, differential diagnosis, hormone, estrogen replacement therapy, reuptake inhibitors, and neurotransmitter.
All relevant articles identified via the search terms reporting original data and published in English were considered for inclusion. Twenty-two cross-sectional and longitudinal studies were utilized to evaluate the relationship between the menopausal transition and risk of mood disorders and to formulate recommendations for screening and management of MDD in perimenopausal and postmenopausal women.
RESEARCH STUDIES UTILIZED THE FOLLOWING MEASURES: postal questionnaires, Women's Health Questionnaire, Beck Depression Inventory, Center for Epidemiologic Studies-Depression scale, Modified Menopause Symptom Inventory, 12-item symptom questionnaire, or Structured Clinical Interview for DSM-IV.
Menopause is a normal, and for most women largely uneventful, part of life. For some women, however, the menopausal transition is a period of biologic vulnerability with noticeable physiologic, psychological, and somatic symptoms. The perimenopausal period is associated with a higher vulnerability for depression, with risk rising from early to late perimenopause and decreasing during postmenopause. Women with a history of depression are up to 5 times more likely to have a MDD diagnosis during this time period.
Routine screening of this at-risk population followed by careful assessment for depressive symptoms can help identify the presence of MDD in the menopausal transition. Recognition of menopausal symptoms, with or without depression, is important given their potential impact on quality of life.
本综述旨在研究围绝经期和绝经后女性发生抑郁症的风险，讨论在绝经过渡期女性中筛查重度抑郁症（MDD）的重要性及基本原理，并综述围绝经期和绝经后女性MDD的治疗选择。
使用以下术语组合在PubMed（1970年至2008年）中进行检索：重度抑郁症、围绝经期、绝经后、情绪障碍、危险因素、生育期、家庭医疗、鉴别诊断、激素、雌激素替代疗法、再摄取抑制剂和神经递质。
通过检索词识别出的所有报告原始数据并以英文发表的相关文章均被考虑纳入。22项横断面和纵向研究被用于评估绝经过渡期与情绪障碍风险之间的关系，并为围绝经期和绝经后女性MDD的筛查及管理制定建议。
研究采用了以下测量方法：邮政问卷、妇女健康问卷、贝克抑郁量表、流行病学研究中心抑郁量表、改良绝经症状量表、12项症状问卷或DSM-IV结构化临床访谈。
绝经是生活中正常的一部分，对大多数女性来说基本平稳。然而，对一些女性而言，绝经过渡期是一个生理脆弱期，伴有明显的生理、心理和躯体症状。围绝经期患抑郁症的易感性更高，风险从围绝经期早期到晚期上升，在绝经后下降。有抑郁症病史的女性在此期间被诊断为MDD的可能性高达5倍。
对这一高危人群进行常规筛查，随后仔细评估抑郁症状，有助于识别绝经过渡期MDD的存在。认识到绝经症状，无论是否伴有抑郁，鉴于其对生活质量的潜在影响都很重要。
