Department of Pharmacology and Therapeutics , Craven , France.
CNRS, National Centre of Scientific Research , Paris , France.
Expert Opin Pharmacother. 2019 Oct;20(15):1837-1845. doi: 10.1080/14656566.2019.1645122. Epub 2019 Jul 29.
: Although postnatal depression is now well recognized, there is also a risk of depressive symptoms during perimenopause. The mechanisms underlying perimenopausal depression are still poorly understood; however, there are available treatment options. : This review describes: the current pharmacotherapeutic approaches for perimenopausal depression, their strengths and weakness, and provides recommendations on how current treatment can be improved in the future. An electronic search identified specific guidelines for the treatment of perimenopausal depression released in 2018, as well as recent clinical studies on the subject. : The 2018 guidelines recommend selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs) as front-line medications for perimenopausal depression, but SSRIs and SNRIs are not always effective. The efficacy of estrogen in perimenopausal depression is well documented, but estrogen is not FDA-approved to treat mood disturbances in perimenopausal women. Clinical practice guidelines currently recommend to restrict hormone therapy to the symptomatic treatment of menopause (not for the prevention of chronic diseases). Research with new estrogenic compounds is under way to improve their benefit/risk ratio in perimenopausal depression.
尽管产后抑郁症现在已经得到广泛认识，但围绝经期也存在出现抑郁症状的风险。围绝经期抑郁症的发病机制仍不清楚，但已有可用的治疗选择。
本综述描述了围绝经期抑郁症的当前药物治疗方法、其优缺点，并就如何改进当前治疗提出了建议。通过电子检索，确定了 2018 年发布的围绝经期抑郁症治疗具体指南，以及近期关于该主题的临床研究。
2018 年指南建议选择性 5-羟色胺再摄取抑制剂（SSRIs）和 5-羟色胺和去甲肾上腺素再摄取抑制剂（SNRIs）作为围绝经期抑郁症的一线药物，但 SSRIs 和 SNRIs 并不总是有效。雌激素治疗围绝经期抑郁症的疗效已有充分记录，但雌激素并未获得 FDA 批准用于治疗围绝经期女性的情绪障碍。临床实践指南目前建议将激素疗法限于绝经症状的对症治疗（不用于预防慢性病）。正在进行新的雌激素化合物的研究，以改善其在围绝经期抑郁症中的获益/风险比。
