Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Psychoneuroendocrinology. 2013 Jul;38(7):1133-44. doi: 10.1016/j.psyneuen.2012.11.006. Epub 2012 Dec 6.
Most women on combined oral contraceptives (COC) report high levels of satisfaction, but 4-10% complain of adverse mood effects. The aim of this randomized, double-blinded, placebo-controlled trial was to investigate if COC use would induce more pronounced mood symptoms than placebo in women with previous history of COC-induced adverse mood. A second aim was to determine if COC use is associated with changes in brain reactivity in regions previously associated with emotion processing.
Thirty-four women with previous experience of mood deterioration during COC use were randomized to one treatment cycle with a levonorgestrel-containing COC or placebo. An emotional face matching task (vs. geometrical shapes) was administered during functional magnetic resonance imaging (fMRI) prior to and during the COC treatment cycle. Throughout the trial, women recorded daily symptom ratings on the Cyclicity Diagnoser (CD) scale.
During the last week of the treatment cycle COC users had higher scores of depressed mood, mood swings, and fatigue than placebo users. COC users also had lower emotion-induced reactivity in the left insula, left middle frontal gyrus, and bilateral inferior frontal gyri as compared to placebo users. In comparison with their pretreatment cycle, the COC group had decreased emotion-induced reactivity in the bilateral inferior frontal gyri, whereas placebo users had decreased reactivity in the right amygdala.
COC use in women who previously had experienced emotional side effects resulted in mood deterioration, and COC use was also accompanied by changes in emotional brain reactivity. These findings are of relevance for the understanding of how combined oral contraceptives may influence mood. Placebo-controlled fMRI studies in COC sensitive women could be of relevance for future testing of adverse mood effects in new oral contraceptives.
大多数服用复方口服避孕药（COC）的女性报告称满意度很高，但仍有 4-10%的女性报告出现不良情绪影响。本随机、双盲、安慰剂对照试验的目的是研究既往 COC 引起不良情绪的女性使用 COC 是否会引起更明显的情绪症状，以及 COC 使用是否与先前与情绪处理相关的大脑反应区域的变化相关联。
34 名曾有 COC 引起情绪恶化经历的女性被随机分配至接受含左炔诺孕酮的 COC 或安慰剂治疗一个周期。在开始和结束 COC 治疗周期期间，采用情绪面孔匹配任务（与几何形状相比）进行功能性磁共振成像（fMRI）。在整个试验过程中，女性使用 Cyclicity Diagnoser（CD）量表记录每日症状评分。
在治疗周期的最后一周，COC 使用者的抑郁情绪、情绪波动和疲劳评分均高于安慰剂使用者。与安慰剂使用者相比，COC 使用者左侧脑岛、左侧额中回和双侧额下回的情绪诱导反应性也较低。与治疗前周期相比，COC 组双侧额下回的情绪诱导反应性降低，而安慰剂组右侧杏仁核的反应性降低。
曾有情绪副作用的女性使用 COC 会导致情绪恶化，同时 COC 使用还伴随着情绪大脑反应性的变化。这些发现对理解 COC 如何影响情绪具有重要意义。在 COC 敏感的女性中进行安慰剂对照 fMRI 研究，可能有助于未来测试新的口服避孕药的不良情绪影响。
