de Wit Anouk E, Giltay Erik J, de Boer Marrit K, Nathan Margo, Wiley Aleta, Crawford Sybil, Joffe Hadine
Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Thorn 1117, MA 02115, United States.
Department of Psychiatry, Leiden University Medical Center, 2300 RC B1-P, The Netherlands.
Psychoneuroendocrinology. 2021 Apr;126:105128. doi: 10.1016/j.psyneuen.2021.105128. Epub 2021 Jan 7.
Irritability is a highly burdensome complaint, commonly, but not universally, linked with depressive symptoms. While increased variability in estradiol has been associated with depressive symptoms during perimenopause, more insight is needed into reproductive hormone dynamics and other factors that predispose perimenopausal women to irritable mood.
Among 50 mildly depressed perimenopausal women (mean (SD) age 48.4 (3.9) years), severity of irritability symptoms (on Symptom Questionnaire Hostility subscale, range 0-23) was assessed weekly for eight weeks, concurrent with potential predictors. Associations between these were examined using generalized estimating equating models.
Most women (82.0%) reported having moderate to severe irritability at least once. However, the severity of irritability was highly variable from week-to-week (between-subject mean coefficient of variation [CV] 72.9% and within-subject mean CV 63.7%). In multivariate analyses, less variable serum estradiol levels (standardized β within-person CV -0.23 95%CI [-0.32, -0.14], p < 0.001), greater depression severity (0.45 [0.35, 0.56], p < 0.001), younger age (-0.23, [-0.28, -0.09], p < 0.001), and more frequent vasomotor symptoms (0.14 [0.05, 0.23], p = 0.002) were associated with more irritability. Depression severity explained the largest portion of the variance in irritability, but still not more than 20.3%. Neither crude values, weekly change in, or variability of progesterone or FSH levels were associated with irritability.
Irritability was highly prevalent among mildly depressed perimenopausal women. In contrast to depressive symptoms, decreased rather than increased variability in estradiol levels was associated with more irritability. This highlights that irritable mood can be disentangled from depressive symptoms in perimenopausal women and might be linked with different estradiol dynamics.
易怒是一种负担很重的主诉，通常但并非普遍与抑郁症状相关。虽然围绝经期雌二醇变异性增加与抑郁症状有关，但对于生殖激素动态变化以及使围绝经期女性易出现易怒情绪的其他因素，仍需要更深入的了解。
在50名轻度抑郁的围绝经期女性（平均（标准差）年龄48.4（3.9）岁）中，连续八周每周评估易怒症状的严重程度（使用症状问卷敌意分量表，范围0 - 23），同时评估潜在预测因素。使用广义估计方程模型检查这些因素之间的关联。
大多数女性（82.0%）报告至少有一次中度至重度易怒。然而，易怒的严重程度在周与周之间变化很大（受试者间平均变异系数[CV]为72.9%，受试者内平均CV为63.7%）。在多变量分析中，血清雌二醇水平变异性较小（标准化β受试者内CV -0.23，95%置信区间[-0.32, -0.14]，p < 0.001）、抑郁严重程度更高（0.45 [0.35, 0.56]，p < 0.001）、年龄更小（-0.23，[-0.28, -0.09]，p < 0.001）以及血管舒缩症状更频繁（0.14 [0.05, 0.23]，p = 0.002）与更易怒相关。抑郁严重程度解释了易怒变异的最大部分，但仍不超过20.3%。孕酮或促卵泡生成素水平的原始值、每周变化或变异性均与易怒无关。
易怒在轻度抑郁的围绝经期女性中非常普遍。与抑郁症状相反，雌二醇水平变异性降低而非增加与更易怒相关。这突出表明，围绝经期女性的易怒情绪可以与抑郁症状区分开来，并且可能与不同的雌二醇动态变化有关。
