Sichel D A, Cohen L S, Robertson L M, Ruttenberg A, Rosenbaum J F
Clinical Psychopharmacology Unit, Massachusets General Hospital, Boston 02114, USA.
Biol Psychiatry. 1995 Dec 15;38(12):814-8. doi: 10.1016/0006-3223(95)00063-1.
Seven women with histories of puerperal psychosis and four with histories of puerperal major depression were consecutively treated with high-dose oral estrogen immediately following delivery. None of the women had histories of nonpuerperal affective disorder, and all women were affectively well throughout the current pregnancy and at delivery. Despite the high risk for recurrent illness in this population, only one woman developed relapse of postpartum affective disorder. All others remained entirely well and required no treatment with psychotropic medications during the 1 year follow-up period. This low rate of relapse, 9% compared to an expected 35-60% without prophylaxis, suggests that oral estrogen may stem the rapid rate of change in estrogen following delivery, thereby preventing the potential impact on dopaminergic and serotonergic neuroreceptors. It is hypothesized that the rapid rate of change of estrogen after delivery creates an "estrogen withdrawal state." This may be a critical factor in driving acute puerperal affective psychosis and early-onset puerperal major depression.
七名有产褥期精神病病史的女性和四名有产褥期重度抑郁症病史的女性在分娩后立即连续接受高剂量口服雌激素治疗。这些女性均无非产褥期情感障碍病史，且在本次妊娠期间及分娩时情感状态均良好。尽管该人群复发疾病的风险很高，但只有一名女性出现了产后情感障碍复发。在1年的随访期内，所有其他女性均完全康复，无需使用精神药物治疗。与预期的无预防措施时35%-60%的复发率相比，9%的低复发率表明口服雌激素可能阻止分娩后雌激素的快速变化，从而防止对多巴胺能和5-羟色胺能神经受体产生潜在影响。据推测，分娩后雌激素的快速变化会产生一种“雌激素撤退状态”。这可能是导致急性产褥期情感性精神病和早发性产褥期重度抑郁症的关键因素。
