国际生殖健康/计划生育杂志

国际生殖健康/计划生育 ›› 2015, Vol. 34 ›› Issue (4): 349-352.

• 综述 • 上一篇    

围绝经期抑郁症的治疗进展

崔莉莉，王冬娜，毛佩贤，任艳萍，汤宜朗   

  1. 100088 北京，首都医科大学北京安定医院（崔莉莉，毛佩贤，任艳萍，汤宜朗）；首都医科大学北京宣武医院妇产科（王冬娜）；美国乔治亚州亚特兰大埃默里大学精神病学和行为科学系（汤宜朗）
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2015-07-15 发布日期:2015-07-15

Diagnosis and Treatment for Perimenopausal Depressive Disorder

CUI Li-li，WANG Dong-na，MAO Pei-xian，REN Yan-ping，TANG Yi-lang   

  1. Beijing Anding Hospital，Capital Medical University，Beijing 100088，China（CUI Li-li，MAO Pei-xian，REN Yan-ping，TANG Yi-lang）；Department of Obstetrics and Gynecology，Beijing Xuanwu Hospital，Capital Medical University，Beijing 100053，China（WANG Dong-na）；Department of Psychiatry and Behavioral Sciences，Emory University，Atlanta，Georgia，USA（TANG Yi-lang）
  • Received:1900-01-01 Revised:1900-01-01 Published:2015-07-15 Online:2015-07-15

PDF (PC)

7643

摘要： 围绝经期是新发和复发抑郁症的危险期，围绝经期抑郁症（perimenopausal depressive disorder，PDD）是影响中年女性身心健康和生活质量的常见障碍。PDD发生的始动因素是由于卵巢功能衰退，雌激素分泌减少，对下丘脑、垂体的负反馈减弱，导致下丘脑-垂体-性腺轴的功能紊乱。女性围绝经期性激素水平的波动可增加抑郁症的患病风险。未经治疗的抑郁症不仅可以加重原有抑郁症疾病进程，而且增加躯体疾病的风险，包括加重心血管疾病、糖尿病和骨质疏松症等。关于PDD的治疗研究很多，目前主要以抗抑郁剂进行治疗，对一些难治性抑郁症考虑合并雌激素治疗，其可加速抗抑郁剂的起效时间。长期雌激素治疗会增加患乳腺癌、子宫内膜癌的风险，在雌激素治疗的同时一般合并应用孕激素。综述雌激素补充治疗和抗抑郁剂治疗以及两者的联合治疗。

关键词: 围绝经期, 抑郁症, 抑郁症, 更年期, 雌激素替代疗法, 抗抑郁剂

Abstract: Perimenopause period is a high risk period of new and recurrent depression. Perimenopausal depressive disorder (PDD) is a common disorder related to the physical and mental health, as well as life quality, of middle aged women. The initial factor of PDD is the degradation of ovarian function, which lead to the decreased estrogen and the weaken negative feedback to hypothalamus and pituitary. The fluctuating hormonal level during the menopausal transition may increase vulnerability to depression. Perimenopausal depression may not only accelerate the primary course of depression, but also increase the risk of physical disorders including cardiovascular disease, diabetes and osteoporosis. Studies on the treatment of perimenopausal disorder showed that the main treatment was antidepressant, and antidepressant combined with hormone replacement for those refractory PDD patients. Because long term of estrogen therapy could increase the risk of breast canscer and endometrial carcinoma, it is usual that progesterone was combined with estrogen in clinical practice. This review introduced the combined therapy with estrogen and antidepressant for PDD.

Key words: Perimenopause, Depressive disorder, Depressive dsorder, major, Estrogen replacement therapy, Antidepressive agents