雌激素对妇女围绝经与绝经期抑郁障碍的影响

目的 探讨围绝经期与绝经期抑郁障碍妇女的雌激素水平以及用雌激素治疗妇女围绝经期与绝经期抑郁障碍的效果.方法 采用磁酶联免疫技术检测了30例围绝经期和绝经期抑郁障碍妇女血清雌激素、卵泡刺激素、黄体生成素水平.用雌激素(单用组)或联合应用抗抑郁药物(联合组)治疗围绝经期和绝经期抑郁障碍妇女,并用Hamiltom抑郁量表评估抑郁症状的治疗效果;用围绝经期及绝经期症状评分量表评估围绝经期和绝经期症状的治疗效果.结果 围绝经期与绝经期抑郁障碍妇女血清雌激素水平明显低于正常围绝经期及绝经期妇女(P＜0.05).治疗后两组Hamiltom抑郁量表总分均明显下降(P＜0.001);联合组和单用组的减分率分别为70.53%和58.24%,两组比较有显著性差异(P＜0.05).联合组和单用组的总有效率分别为93.33%和80%,联合组高于单用组,但无统计学意义(P＞0.05).治疗后两组围绝经期及绝经期症状评分均明显下降,差异非常显著(P＜0.001);联合组和单用组的减分率(73.99%和70.66%)、联合组和单用组的总有效率(96.67%和93.33%)也无明显差异(P＞0.05).结论 围绝经期与绝经期抑郁障碍的发生与雌激素水平的降低有关,因此采用雌激素治疗围绝经期与绝经期抑郁障碍可以取得良好的效果.受雌激素水平的影响,在原来抗抑郁药物的基础上,联合应用雌激素对提高疗效的作用更明显.

Effect of estrogen on depressive disorder of perimenopausal and postmenopausal women

Objective To detect serum levels of estrogen,FSH and LH of perimenopausal and postmenopausal women with depressive disorder and observe clinical therapeutic effect of estrogen therapy(ET) on depressive disorder of the perimenopausal and postmenopausal women.Methods Serum levels of estrogen,FSH and LH of 30 perimenopausal and postmenopausal women with depressive disorder and 30 normal perimenopausal and postmenopausal women were detected by using magnetism-ELISA.44 perimenopausal and postmenopausal women with depressive disorder received 2.5mg/day of tibolone(estrogen) for two weeks and a maintainence dose of 1.25mg/day from the third week for 6 weeks(estrogen alone group),and other 40 perimenopausal and postmenopausal women with depressive disorder received combination of same dose of estrogen and 20mg of paroxitin(an antidepressant) at the same time(combination treatment group).23 women lost in the trail.Hamilton Depression Rating Scale(HDRS) was used to evaluate therapeutic effect for depressive disorder of the women and Kupperman index(KMI) was used to evaluate perimenopausal and postmenopausal symptoms of the women at baseline and the eighth week of treatment(end of the trail).Results The serum level of estrogen of perimenopausal and postmenopausal women with depressive disorder was lower than that of those normal perimenopausal and postmenopausal women(P<0.05).No difference was found in FSH and LH between the two groups.All the women in the two groups showed a significant reduction in HDRS and KMI scores at the end of the 8-week trial(both P<0.01).In the combined treatment group,HDRS score decrease rate was 70.53% and that in the estrogen alone group was 58.24%,and there was a significant difference between the two groups(P<0.05).The total effective rate for depressive disorder in the combined treatment group was 93.33% and that in the estrogen alone group was 80% and there was no significant difference between the two groups(P>0.05).In the combined treatment group,KMI score decrease rate was 73.99% and that in the estrogen alone group was 70.66%,and there was no significant difference between the two groups(P>0.05),and the total effective rate for perimenopausal and postmenopausal symptoms in the combined treatment group was 93.33% and that in the estrogen alone group was 80% and there was no significant difference between the two groups(P>0.05).Conclusion Perimenopausal and postmenopausal depressive disorder is correlated with decreased serum estrogen level of the women.So,estrogen is effective for perimenopausal and postmenopausal women with depressive disorder.Combination of antidepressant and estrogen is the best solution for perimenopausal and postmenopausal depressive disorder,but the treatment should be individualized.