与双相情感障碍恶化相关的女性生殖阶段进展。
Progression of female reproductive stages associated with bipolar illness exacerbation.
机构信息
Department of Psychiatry, University of Massachusetts Medical School and UMass Memorial Health Care, Worcester, MA 01605, USA.
出版信息
Bipolar Disord. 2012 Aug;14(5):515-26. doi: 10.1111/j.1399-5618.2012.01026.x. Epub 2012 May 31.
OBJECTIVES
Late perimenopause and early postmenopause confer an increased risk of depression in the population, yet bipolar disorder mood course during these times remains unclear.
METHODS
Clinic visits in 519 premenopausal, 116 perimenopausal (including 13 women transitioning from perimenopause to postmenopause), and 133 postmenopausal women with bipolar disorder who received naturalistic treatment in the multisite Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study over 19.8 ± 15.5 months were analyzed for mood state. History of postpartum and perimenstrual mood exacerbation and current hormone therapy were evaluated as potential mood predictors.
RESULTS
A progression in female reproductive stage (premenopause, perimenopause, and postmenopause) was significantly associated with percent of visits decreasing in euthymia (29.3%, 27.0%, 25.0%, respectively, p < 0.05), decreasing in syndromal mood elevation (5.3%, 4.1%, and 3.0%, respectively, p < 0.001), and increasing in subsyndromal symptoms (47.3%, 50.7%, and 52.7%, respectively, p = 0.05). Thirteen women transitioning from peri- to postmenopause had a significantly greater proportion of visits in syndromal depression (24.4%, p < 0.0005) compared to premenopausal, perimenopausal, and postmenopausal women, while depression in the latter three groups (18.1%, 18.1%, and 19.3%, respectively) did not differ. Perimenstrual and/or postpartum mood exacerbation, or hormone therapy did not significantly alter depression during perimenopause.
CONCLUSIONS
A progression in female reproductive stages was associated with bipolar illness exacerbation. A small number of women transitioning from perimenopause to postmenopause had significantly greater depression than other female reproductive groups. Euthymia and mood elevation decreased with progressing female reproductive stage. Menstrual cycle or postpartum mood exacerbation, or current hormone therapy use, was not associated with perimenopausal depression. Future studies, which include hormonal assessments, are needed to confirm these preliminary findings.
目的
绝经后期和绝经前期会增加人群患抑郁症的风险，但在这些时期双相情感障碍的情绪变化仍不清楚。
方法
对 519 名绝经前、116 名围绝经期（包括 13 名从围绝经期过渡到绝经后期的女性）和 133 名绝经后患有双相情感障碍的女性进行了分析，这些女性在多中心系统治疗增强计划治疗双相情感障碍（STEP-BD）研究中接受了自然治疗，共 19.8±15.5 个月。分析了情绪状态。评估了产后和围经期情绪恶化的病史以及当前激素治疗是否为潜在的情绪预测因素。
结果
女性生殖阶段（绝经前、围绝经期和绝经后）的进展与无躁狂期就诊次数的百分比呈显著负相关（分别为 29.3%、27.0%和 25.0%，p<0.05），与综合征性情绪升高的就诊次数呈显著负相关（分别为 5.3%、4.1%和 3.0%，p<0.001），与亚综合征症状的就诊次数呈显著正相关（分别为 47.3%、50.7%和 52.7%，p=0.05）。13 名从围绝经期过渡到绝经后期的女性在综合征性抑郁就诊次数中所占比例显著较高（24.4%，p<0.0005），而绝经前、围绝经期和绝经后女性的比例分别为 18.1%、18.1%和 19.3%，没有显著差异。围经期和/或产后情绪恶化或激素治疗并未显著改变围绝经期的抑郁。
结论
女性生殖阶段的进展与双相情感障碍的恶化有关。一小部分从围绝经期过渡到绝经后期的女性比其他女性生殖群体的抑郁程度显著更高。无躁狂期和情绪升高随女性生殖阶段的进展而减少。月经周期或产后情绪恶化或当前激素治疗的使用与围绝经期抑郁无关。需要进一步的研究，包括激素评估，以证实这些初步发现。
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