Chen Li-Chi, Yang Albert C, Su Tung-Ping, Bai Ya-Mei, Li Cheng-Ta, Chang Wen-Han, Chen Tzeng-Ji, Tsai Shih-Jen, Chen Mu-Hong
Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, 11217, Taipei, Taiwan.
Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Arch Womens Ment Health. 2017 Jun;20(3):463-468. doi: 10.1007/s00737-017-0725-x. Epub 2017 Apr 20.
Previous studies suggested that menopausal transition played an important role in the clinical course of major depression and bipolar disorder. However, the role of symptomatic menopausal transition in diagnostic conversion from major depression to bipolar disorder was still unknown. Using the Taiwan National Health Insurance Research Database, 50,273 midlife women aged between 40 and 60 years in 2002∼2008 with major depression were enrolled in our study and divided into two subgroups based on the presence (n = 21,120) or absence (n = 29,153) of symptomatic menopausal transition. Subjects who had subsequent bipolar disorder during the follow-up were identified. Midlife women with major depression and symptomatic menopausal transition had a higher incidence of the diagnostic conversion to bipolar disorder (7.3 vs. 6.6%, p = 0.003) than those with major depression alone. Cox regression analysis after adjusting for demographic data and psychiatric comorbidities further showed that symptomatic menopausal transition was associated with an increased risk of developing bipolar disorder (HR 1.14, 95% CI 1.07∼1.23) among midlife women with major depression. Sensitivity test after excluding the 1-year and 3-year observation exhibited the consistent findings (HR 1.18, 95% CI 1.09∼1.28; HR 1.20, 95% CI 1.08∼1.34). Midlife women with the dual diagnoses of major depression and symptomatic menopausal transition had an increased risk of the diagnostic conversion to bipolar disorder compared to those with major depression alone. Further studies may be required to investigate the underlying mechanisms among menopausal transition and the diagnostic conversion from major depression to bipolar disorder.
以往研究表明，绝经过渡在重度抑郁症和双相情感障碍的临床病程中起重要作用。然而，有症状的绝经过渡在重度抑郁症向双相情感障碍诊断转换中的作用仍不明确。利用台湾国民健康保险研究数据库，我们纳入了2002年至2008年间年龄在40至60岁之间的50273名患有重度抑郁症的中年女性，并根据是否存在有症状的绝经过渡将她们分为两个亚组（有症状组n = 21120，无症状组n = 29153）。确定随访期间出现双相情感障碍的受试者。与仅患有重度抑郁症的中年女性相比，患有重度抑郁症且有症状的绝经过渡的中年女性诊断转换为双相情感障碍的发生率更高（7.3%对6.6%，p = 0.003）。在调整人口统计学数据和精神共病后进行的Cox回归分析进一步表明，有症状的绝经过渡与患有重度抑郁症的中年女性发生双相情感障碍的风险增加有关（风险比1.14，95%置信区间1.07至1.23）。排除1年和3年观察期后的敏感性测试显示了一致的结果（风险比1.18，95%置信区间1.09至1.28；风险比1.20，95%置信区间1.08至1.34）。与仅患有重度抑郁症的女性相比，患有重度抑郁症和有症状的绝经过渡双重诊断的中年女性诊断转换为双相情感障碍的风险增加。可能需要进一步研究来探讨绝经过渡与重度抑郁症向双相情感障碍诊断转换之间的潜在机制。
