激素替代治疗围绝经期抑郁症疗效观察

目的 探讨激素替代治疗围绝经期抑郁症患者的临床疗效.方法 将201 8年12月～2019年12月本院接收的104例围绝经期抑郁症患者通过电脑随机分为两组,每组52例患者.常规组予以单纯抗抑郁药物治疗,研究组予以抗抑郁药物治疗+激素替代治疗.比较两组的效果.结果 研究组临床疗效高于常规组(P＜0.05);研究组用药之后第...     

抗抑郁药及性激素治疗围绝经期及绝经后妇女抑郁症的疗效比较

目的 比较抗抑郁药及性激素治疗围绝经期及绝经后妇女抑郁症的临床疗效.方法 将120例围绝经期及绝经后抑郁症女性按入组顺序分为A、B、C3组(每组40例),采用24项汉密尔顿抑郁量表(HAMD24)对其进行抑郁程度评价,然后根据HAMD评分每组再分为轻中度组及重度组2个亚组.A组应用抗抑郁药盐酸氟西汀(20 mg/d)+性激素替勃龙(1.25 mg/d)治疗,B组应用盐酸氟西汀( 20 mg/d)治疗,C组应用替勃龙(1.25 mg/d)治疗;连续服药2个月后进行HAMD24评定,同时计算治疗总有效率.结果 (1)临床疗效比较:A、B、C3组的轻中度亚组治疗总有效率分别为96％、95％、93％,差异无统计学意义(P＞0.05);重度亚组治疗总有效率分别为93％、83％、46％,A、B2组的重度亚组治疗总有效率明显高于C组(P＜0.05),且A组的重度亚组治疗总有效率高于B组(P＜0.05).(2)治疗前后HAMD24评分比较:治疗后3组的轻中度亚组HAMD24评分比较差异无统计学意义(P＞0.05),但治疗后HAMD24评分均明显低于治疗前基线水平[治疗前分别为(29.0±4.8)、(27.4±5.3)、(27.9±4.2)分,治疗后分别为(3.9±3.2)、(4.2±3.6)、(4.4±3.0)分;P＜0.05];治疗后,A、B2组重度亚组的HAMD24评分明显低于C组[治疗前分别为(38.2±5.4)、(37.8±4.9)、(37.3±5.3)分,治疗后分别为(5.7±2.5)、(8.4±2.8)、(20.8±5.2)分; P＜0.05],且A组重度亚组的HAMD24评分低于B组(P＜0.05).结论 围绝经期及绝经后合并轻中度抑郁症妇女抗抑郁药治疗及激素替代治疗效果相当,重度抑郁症女性则两药联用效果更佳.     

围绝经期抑郁症影响因素探讨

围绝经期抑郁症严重影响妇女的身心健康和生活质量.本研究的目的在于了解围绝经期妇女抑郁症发病的相关因素,针对病因对其进行预防,以提高围绝经期妇女的生活质量. 1 对象与方法 1.1、对象对2007-01～2008-09大丰市的围绝经期妇女随机抽样调查.进入调查妇女共112例,除外智力障碍、脑部疾病及精神病病史,自愿合作经指导能理解问卷内容.     

围绝经期抑郁症的中医治疗研究进展

抑郁症是围绝经期女性常见的精神疾病之一，而传统，中医治疗围绝经期抑郁症中受到越来越大的关注。本文对中医药治疗围绝经期抑郁症的研究进展作一综述。     

针刺治疗围绝经期抑郁症的临床研究

目的 观察针刺治疗围绝经期抑郁症的疗效.方法 将60例围绝经期抑郁症患者随机分为研究组和对照组各30例.对照组予口服盐酸氟西汀系统治疗.研究组予针刺治疗,每日治疗一次,两周为一疗程,治疗四个疗程,共八周.两组均于治疗前及治疗第2、4、8周末采用汉密尔顿抑郁症状评定量表(HAMD)及副反应量表(TESS)评定临床疗效及不良反应.结果 研究组HAMD总分由治疗前(26.84±3.39)分下降至治疗8周后(8.10±5.07)分,对照组由治疗前(25.71±2.56)分下降至8周后(8.52±6.15)分.两组治疗后各周HAMD总分均较治疗前显著减少(P均<0.05).两组间比较HAMD评分均无显著性差异(P均>0.05).研究组显效率为66.67%,有效率为96.67%,对照组显效率为73.33%,有效率为93.33%,两组疗效比较差异无显著性(P>0.05).结论 针刺治疗围绝经期抑郁症的疗效较好,无明显不良反应.     

围绝经期抑郁症诊治分析

围绝经期抑郁症是指初次发病于围绝经期,以情绪低落、焦虑不安、失眠为主要症状的疾病,发病年龄多在45～55岁,祖国医学称为郁症。自2005-01～2009-01,我院应用中西医结合的方法进行治疗并与单纯西医治疗进行对比,现报告如下。     

围绝经期抑郁症诊治分析

围绝经期抑郁症是指初次发病于围绝经期,以情绪低落、焦虑不安、失眠为主要症状的疾病[1],发病年龄多在45～55岁,祖国医学称为郁症.     

围绝经期妇女罹患抑郁症的危险因素分析

目的:探讨围绝经期妇女抑郁症的危险因素。方法:80例确诊为抑郁症的围绝经期女性患者(抑郁症组)和120例非抑郁症的围绝经期女性患者(对照组)进行艾森克人格量表(EPQ)、生活事件量表(LES)、社会支持量表(SSRS)的自评,同时检测两组血雌二醇激素(E2)及促卵泡刺激素(FSH)水平并进行比较。结果:抑郁症组血E2水平(t=-8.17,P=0.000)及SSRS主观支持得分(t=-3.44,P=0.001)低于对照组;血FSH水平(t=13.45,P=0.000)、LES总事件刺激分(t=5.42,P=0.00)、负性事件刺激分(t=7.97,P=0.000)、EPQ-N(神经质)分(t=8.32,P=0.000)、EPQ-P(精神质)分(t=3.84,P=0.00)高于对照组。多因素非条件Logistic回归提示,血E2、FSH水平、LES负性事件评分、EPQ-N评分的回归系数β分别为-0.117、1.116、0.372、0.290(P0.01或P0.001)。结论:血E2、FSH水平、社会心理因素、负性事件刺激及神经质人格是围绝经期妇女罹患抑郁症的危险因素。     

瘦素与围绝经期抑郁症的关系及研究进展

围绝经期（perimenopausal period）是女性抑郁症高发期,常表现为情绪低落、心绪紊乱等抑郁症状,且发病基础尚不明确,亟待寻求好的治疗手段。瘦素是一种由脂肪组织分泌的激素,在新陈代谢和神经保护方面均发挥功能。近年来,瘦素被报道对围绝经期抑郁症具有一定的改善作用,且瘦素与雌激素的合成及分泌关系密切。因此瘦素可能成为治疗围绝经期抑郁症的潜在分子靶点。本文针对瘦素与围绝经期抑郁症的关系及相关研究进展进行综述。     

文拉法辛治疗围绝经期抑郁症患者的对照研究

本研究以文拉法辛联合雌激素治疗围绝经期抑郁症患者,并与单用雌激素进行比较,报告如下。1对象和方法为我院2008年6月至2009年12月门诊或住院患者。均为女性;年龄45～60岁;符合世界卫生组织围绝经期定义,Kupperman绝经指数（KMI）≥17分;     

艾司西酞普兰治疗围绝经期抑郁对照观察

目的：观察艾司西酞普兰联合激素对围绝经期中重度抑郁症的临床疗效。方法：50例围绝经期中重度抑郁症患者随机分为合用组和单用组。合用组给予艾司西酞普兰和替勃龙,单用组给予替勃龙,用Montgomery and Asberg抑郁量表（MADRS）和Kupperman绝经指数（KMI）对患者进行治疗8周观察。结果：完成研究43例,其中合用组22例,单用组21例。合用组有效率90．9％,对照组有效率71．4％。合用组治疗1周后MADRS评分与治疗前差异有显著性,而单用组到第2周与治疗前有差异。治疗第2周时,两组之间MADRS评分差异有显著性,这种差异一直持续到8周末。在KMI改善方面,两组在治疗第1周均比治疗前有显著改善,到第2周时,合用组与单用组间KMI评分差异有显著性,这种差异一直持续到8周末。结论：艾司西酞普兰联用雌激素能够在治疗1周内显著改善患者抑郁症状和KMI,并且能够持续改善患者的症状,这种疗效优于单用雌激素治疗。     

The effect of alexithymic features on response to antidepressant medication in patients with major depression

There has been no follow-up study regarding the effect of alexithymic features on antidepressant treatment. This study was planned to observe whether alexithymia effects short-term treatment outcome in depression. The study included 32 alexithymic and 33 nonalexithymic outpatients with major depression. Depression was assessed on the basis of the Structured Clinical Interview for DSM-IV (SCID-I). Level of depression was measured using the 17-item Hamilton Rating Scale for Depression (HAM-D). Alexithymia was screened using the Turkish version of Toronto Alexithymia Scale (TAS-20). All patients received 20 mg/d paroxetine for 10 weeks. Alexithymic and nonalexithymic patients were compared on the HAM-D scores, TAS-20 scores, and rate of response to antidepressant medication. The rate of responders, defined by a reduction of >50% from baseline in HAM-D total score, was 21.9% in the alexithymic group and 54.5% in the nonalexithymic group. Changes in the HAM-D scores were significantly correlated with the TAS-20 scores. TAS-20 scores dropped below 61 in only 31.2% of the alexithymic patients, and 68.8% of patients remained alexithymic. Whereas 50% of patients whose TAS-20 scores dropped below 61 responded to antidepressant medication, this rate was only 9.1% among patients who remained alexithymic. These findings indicated that the stability of alexithymic features had a negative effect on antidepressant treatment in depression.     

Venlafaxine in the treatment of depressive and vasomotor symptoms in women with perimenopausal depression

Perimenopause is often marked by vasomotor symptoms and dysphoria. Antidepressant studies have demonstrated decreased frequency and severity of hot flashes in breast cancer survivors and menopausal women. We hypothesized that venlafaxine would relieve both depressive and vasomotor symptoms in depressed perimenopausal women. Sixteen women fulfilling clinical criteria for climacteric phase and Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria for a depressive episode were enrolled in an open-label 8-week trial of extended-release venlafaxine. Depressive and climacteric symptoms were monitored using the Hamilton Rating Scales for Depression (Ham-D) and Anxiety (Ham-A), Clinical Global Impression (CGI) scale, and Greene Climacteric Scale (GCS). Serum follicular stimulating hormone (FSH) and estradiol concentrations were monitored. Significant decreases in Ham-D and Ham-A scores and the GCS psychiatric subscale were seen after 2 weeks of treatment. In an intention-to-treat analysis, 81% of the subjects demonstrated a therapeutic antidepressant response (>50% decline in Ham-D score) and 75% achieved clinical remission (Ham-D score < or =7) after 8 weeks of venlafaxine therapy (75-225 mg/day). Total GCS scores declined 60%, and GCS vasomotor subscores decreased among those with vasomotor symptoms at baseline. These data suggest that venlafaxine treatment improves overall well-being, reduces depressive symptoms, and may diminish baseline vasomotor symptoms in depressed perimenopausal women. Further studies are warranted to investigate the utility of venlafaxine in perimenopausal depression.     

抑郁症患者前额脑电功率改变以及与抗抑郁剂疗效的相关性

目的:探讨抑郁症患者前额脑电功率与抗抑郁剂疗效的关系. 方法:对40例抑郁症患者(研究组)入院1周内行脑电地形图检查,并和32例正常对照组进行对照分析;同时对患者在治疗前后进行HAMD评定. 结果:前额脑波α1,δ,θ频段功率研究组较对照组明显升高,组间差异具有统计学意义(P＜0.05);研究组左前额δ波功率与HAMD第2周减分率有统计学意义的负相关(P＜0.05);研究组左前额β波功率与HAMD第6周减分率有统计学意义的负相关(P＜0.05). 结论:抑郁症患者可能存在前额功能损伤;其抗抑郁剂治疗起效时间可能与左前额δ波功率有关,且左前额β功率越高可能提示疗效欠佳.     

Thyroid hormones affect recovery from depression during antidepressant treatment

Aims:  The aim of the present study was to evaluate whether thyroid hormonal changes during menopause may affect the development and the course of major depressive disorder.
Methods:  Thirty-nine female patients ( n  = 17 in pre-menopause; n  = 22 in post-menopause) with major depressive disorder based on Diagnostic Statistical Manual of Mental Disorders (4th edition) criteria and who were euthyroid and not on hormonal replacement therapy, participated in a prospective, 6-week, open-label naturalistic study. The Hamilton Depression Rating Scale-17 item, the Montgomery-Åsberg Depression Rating Scale, the Clinical Global Impression scale and the Cognitive Failure Questionnaire were administered at baseline, week 1, week 3, and week 6. Levels of thyroid stimulating hormone, total thyroxine and total triiodothyronine were collected at baseline visit.
Results:  In the whole sample, particularly in pre-menopausal women, levels of thyroid stimulating hormone-potential markers of subclinical hypothyroidism were correlated with those of less severe but more resistant depressive form. Conversely, total thyroxine levels were correlated with a more severe depression, but high levels of this hormone favored the response to antidepressants. Overall, a diagnosis of subclinical hypothyroidism was associated with a poor response to antidepressant treatment. Finally, total triiodothyronine levels were associated with better cognitive functioning, though they did not influence improvement occurring with recovery.
Conclusions:  Our study suggests that thyroid hormones may have an impact on severity and efficacy of antidepressant treatment. However, our result should be considered with caution and merely as a suggestion due to some methodological limitations. Hence further studies are required to better ascertain the role of thyroid hormones in depression after menopause.     

三环类抗抑郁药对抑郁症患者淋巴细胞β受体的作用

本文以内源性抑郁症患者为实验对象，研究三环类药物对淋巴细胞肾上腺能β受体的作用．结果提示治疗前抑郁症患者淋巴细胞β受体最大结合（Ｂｍａｘ）明显低于正常，治疗后与正常对照无显著差异，且这一改变与临床疗效一致。受体亲和力无改变。本研究对三环类抗抑郁药的机理探讨，及抑郁症病因研究提供依据。     

Duration of REM sleep latency as predictor of effect of antidepressant therapy

Twenty-three depressed patients were treated with antidepressant drugs or ECT. Thirteen of the depressions were clinically of the endogenous type, and all these patients responded well to therapy. Ten patients suffered from atypical depressions; of these only seven reacted favourably to therapy. EEG showed that patients who were cured had short REM latencies, whereas the three patients who did not respond in a satisfactory way had long REM latencies. These findings suggest that in depressions duration of REM latency may be correlated to respond to antidepressant therapy.     

The influence of concomitant antidepressant medication on safety,tolerability and clinical effectiveness of electroconvulsive therapy

Background: A major problem in the treatment of severe depression is the onset latency until clinical improvement. So far, electroconvulsive therapy (ECT) is the most effective somatic treatment of depression. This holds especially true for treatment-refractory disturbances. However, not all patients respond to conventional unilateral ECT. In certain cases, subsequent clinical response can be achieved using bilateral or high-dose unilateral ECT. Also, a concomitant pharmacotherapy can be utilized to augment therapeutic effectiveness. Surprisingly, data in this field are widely lacking and only few studies showed advantages of an ECT/tricyclic antidepressant combination. Method: We retrospectively evaluated 5482 treatments in 455 patients to investigate possible therapeutic advantages in combination therapies versus ECT monotherapy. Main outcome criteria were clinical effectiveness and tolerability. Moreover, treatment modalities and ictal neurophysiological parameters that might influence treatment outcome were analysed. Results: A total of 18.2% of our treatments were ECT monotherapy, 8.87% were done with one antidepressant. Seizure duration was unaffected by the most antidepressants. SSRI caused a lengthened seizure activity. Postictal suppression was lower in mirtazapine and higher in SSRI and SNRI treated patients. A significant enhancement of therapeutic effectiveness could be seen in the patient group receiving tricyclics, SSRI or mirtazapine. Serious adverse events were not recorded. Conclusion: Our study supports the hypothesis that mirtazapine can be used to enhance the therapeutic effectiveness of ECT. Controlled studies are necessary to further investigate the possible advantages of ECT and pharmacotherapy combinations, especially the use of modern dually acting antidepressants which have proven their good effectiveness in treatment-resistant depression.