Zhuo Chuanjun, Chen Guangdong, Lin Chongguang, Ping Jing, Zhu Jingjing, Wang Lina, Jin Shili, Liu Chuanxin, Zhang Qiuyu, Yang Lei, Li Qianchen, Zhou Chunhua, Cheng Langlang, Tian Hongjun, Song Xueqin
Department of Psychiatry, Wenzhou Seventh Peoples Hospital, Wenzhou, China.
Key Laboratory of Multiple Organs Damage in Patients With Metal Disorder, Tianjin Fourth Center Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin, China.
Front Psychiatry. 2022 Oct 28;13:1012644. doi: 10.3389/fpsyt.2022.1012644. eCollection 2022.
The occurrence of heavy menstrual bleeding (HMB) induced by pharmacological agents has been reported in young adult women. This study aimed to investigate a possible association between the occurrence rates of HMB and different treatment methods such as antidepressant agents alone and in combination with other pharmacological agents. The examined cohort included young women (age 18-35 years, = 1,949) with bipolar disorder (BP) or major depressive disorder (MDD). Menstruation history for 24 months was recorded and evaluated according to pictorial blood loss assessment charts of HMB. Multivariate analyses were conducted to determine odds ratios (ORs) and 95% confidence intervals. The examined antidepressant agents had varying ORs for patients with BP vs. those with MDD. For example, the ORs of venlafaxine-induced HMB were 5.27 and 4.58 for patients with BP and MDD, respectively; duloxetine-induced HMB, 4.72 and 3.98; mirtazapine-induced HMB, 3.26 and 2.39; fluvoxamine-induced HMB, 3.11 and 2.08; fluoxetine-induced HMB, 2.45 and 1.13; citalopram-induced HMB, 2.03 and 1.25; escitalopram-induced HMB, 1.85 and 1.99; agomelatine-induced HMB, 1.45 and 2.97; paroxetine-induced HMB, 1.19 and 1.75; sertraline-induced HMB, 0.88 and 1.13; reboxetine-induced HMB, 0.45 and 0.45; and bupropion-induced HMB, 0.33 and 0.37, in each case. However, when antidepressant agents were combined with valproate, the OR of HMB greatly increased, with distinct profiles observed for patients with BP vs. those with MDD. For example, the ORs of HMB induced by venlafaxine combined with valproate were 8.48 and 6.70 for patients with BP and MDD, respectively; for duloxetine, 5.40 and 4.40; mirtazapine, 5.67 and 3.73; fluvoxamine, 5.27 and 3.37; fluoxetine, 3.69 and 4.30; citalopram, 5.88 and 3.46; escitalopram, 6.00 and 7.55; agomelatine, 4.26 and 5.65; paroxetine, 5.24 and 3.25; sertraline, 4.97 and 5.11; reboxetine, 3.54 and 2.19; and bupropion, 4.85 and 3.46, in each case. In conclusion, some antidepressant agents exhibited potential risks of inducing HMB. Therefore, a combined prescription of antidepressant agents and valproate should be carefully considered for young women with HMB.
据报道，在年轻成年女性中出现了由药物引起的月经过多（HMB）。本研究旨在调查HMB发生率与不同治疗方法之间的可能关联，如单独使用抗抑郁药以及与其他药物联合使用。研究队列包括患有双相情感障碍（BP）或重度抑郁症（MDD）的年轻女性（年龄18 - 35岁，n = 1,949）。根据HMB的图片失血评估图表记录并评估24个月的月经史。进行多变量分析以确定比值比（OR）和95%置信区间。所研究的抗抑郁药在BP患者与MDD患者中的OR有所不同。例如，文拉法辛引起的HMB在BP患者和MDD患者中的OR分别为5.27和4.58；度洛西汀引起的HMB，分别为4.72和3.98；米氮平引起的HMB，分别为3.26和2.39；氟伏沙明引起的HMB，分别为3.11和2.08；氟西汀引起的HMB，分别为2.45和1.13；西酞普兰引起的HMB，分别为2.03和1.25；艾司西酞普兰引起的HMB，分别为1.85和1.99；阿戈美拉汀引起的HMB，分别为1.45和2.97；帕罗西汀引起的HMB，分别为1.19和1.75；舍曲林引起的HMB，分别为0.88和1.13；瑞波西汀引起的HMB，分别为0.45和0.45；安非他酮引起的HMB，分别为0.33和0.37。然而，当抗抑郁药与丙戊酸盐联合使用时，HMB的OR大幅增加，BP患者与MDD患者呈现出不同的特征。例如，文拉法辛与丙戊酸盐联合引起的HMB在BP患者和MDD患者中的OR分别为8.48和6.70；度洛西汀，分别为5.40和4.40；米氮平，分别为5.67和3.73；氟伏沙明，分别为5.27和3.37；氟西汀，分别为3.69和4.30；西酞普兰，分别为5.88和3.46；艾司西酞普兰，分别为6.00和7.55；阿戈美拉汀，分别为4.26和5.65；帕罗西汀，分别为5.24和3.25；舍曲林，分别为4.97和5.11；瑞波西汀，分别为3.54和2.19；安非他酮，分别为4.85和3.46。总之，一些抗抑郁药表现出诱发HMB的潜在风险。因此对于有HMB的年轻女性，应谨慎考虑抗抑郁药与丙戊酸盐的联合处方。
