Effects of acute estradiol and progesterone on perimenstrual exacerbation of suicidal ideation and related symptoms: a crossover randomized controlled trial.
Effects of acute estradiol and progesterone on perimenstrual exacerbation of suicidal ideation and related symptoms: a crossover randomized controlled trial.
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DOI：
10.1038/s41398-022-02294-1
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发表时间：
2022-12-30
影响因子：
6.8
通讯作者：
Girdler, Susan S.
中科院分区：
文献类型：
--
作者：
Eisenlohr-Moul, Tory A.;Bowers, Savannah M.;Prinstein, Mitchell J.;Schmalenberger, Katja M.;Walsh, Erin C.;Young, Steven L.;Rubinow, David R.;Girdler, Susan S.
女性自杀企图的高峰在尿道周围--月经开始前后--此时卵巢类固醇雌二醇（E2）和孕酮（P4）迅速下降。鉴于临床前证据表明，从E2或P4中退出可以引起与自杀风险升高一致的行为，我们假设从这些类固醇中的一种或两种中退出有助于自杀意念（SI）和相关症状的围绝经期加重。在一项随机、对照、双盲交叉实验（NCT 03720847）中，报告上个月SI的自然循环、医学上健康的精神科门诊患者的转诊断样本在两个不同的14天实验间隔（第7-20天，其中促黄体激素激增=第0天）期间完成了两种情况，间隔一个月的洗脱周期。在E2和P4（EP）条件下，参与者接受透皮E2（0.1 mg/天）加口服微粉化P4（200 mg/天，100 mg，每日两次），以缓冲围绝经期类固醇戒断。匹配的安慰剂（PBO）条件允许自然的围绝经期类固醇戒断。参与者报告了每日SI和计划（主要结局）以及抑郁指数（情绪低落，绝望），威胁敏感度（焦虑，感知压力），执行功能（难以集中注意力，冲动）和社会认知偏差（拒绝敏感性，感知负担）。在基线周期中，没有参与者符合DSM-5经前焦虑障碍的前瞻性标准，但59%的参与者符合除完全滤泡症状缓解外的所有标准，93%的参与者在围月经期表现出最高的SI。在29例随机分配的患者中，对28例进行了分析（14例EP-PBO，14例PBO-EP）。E2和P4（相对于PBO）的实验管理减少了SI，自杀计划，抑郁，绝望，感知压力，拒绝敏感性和感知负担的围绝经期恶化，特别是在围绝经期（自然E2和P4退出）天。此外，延迟退出实验E2和P4（但不是PBO）概括SI，绝望和排斥敏感性。围月经期急性停用卵巢激素可能在抑郁和SI的围月经期恶化中起因果作用。
Female suicide attempts peak peri-menstrually—around the onset of menses—when the ovarian steroids estradiol (E2) and progesterone (P4) fall rapidly. Given preclinical evidence that withdrawal from either E2 or P4 can provoke behaviors consistent with elevated suicide risk, we hypothesized that withdrawal from one or both of these steroids contributes to perimenstrual exacerbation of suicidal ideation (SI) and related symptoms. In a randomized, controlled, double-blind crossover experiment (NCT03720847), a transdiagnostic sample of naturally cycling, medically healthy psychiatric outpatients reporting past-month SI completed two conditions during two different 14-day experimental intervals (days 7–20 where the luteinizing hormone surge = day 0), separated by a monthlong washout cycle. In the E2 and P4 (EP) condition, participants received transdermal E2 (0.1 mg/day) plus oral micronized P4 (200 mg/day as 100 mg twice daily) to buffer perimenstrual steroid withdrawal. A matched placebo (PBO) condition allowed natural perimenstrual steroid withdrawal. Participants reported daily SI and planning (primary outcomes) and indices of depression (low mood, hopelessness), threat sensitivity (anxiety, perceived stress), executive functioning (difficulty concentrating, impulsivity), and social cognitive bias (rejection sensitivity, perceived burdensomeness). In baseline cycles, no participant met prospective criteria for DSM-5 premenstrual dysphoric disorder, but 59% met all criteria except full follicular symptom remission, and 93% showed the highest SI in the perimenstrual phase. Of 29 randomized, 28 were analyzed (14 EP-PBO, 14 PBO-EP). Experimental administration of E2 and P4 (relative to PBO) reduced perimenstrual exacerbation of SI, suicide planning, depression, hopelessness, perceived stress, rejection sensitivity, and perceived burdensomeness, particularly in the perimenstrual (natural E2 and P4 withdrawal) days. Further, delayed withdrawal from experimental E2 and P4 (but not PBO) recapitulated SI, hopelessness, and rejection sensitivity. Acute perimenstrual withdrawal from ovarian steroids may play a causal role in perimenstrual worsening of depression and SI.
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影响因子：
5
作者：
COHEN, S;KAMARCK, T;MERMELSTEIN, R
通讯作者：
MERMELSTEIN, R
影响因子：
3.6
作者：
Frye, C. A.;Paris, J. J.;Rhodes, M. E.
通讯作者：
Rhodes, M. E.
影响因子：
4.9
作者：
Andreen, L.;Spigset, O.;Backstrom, T.
通讯作者：
Backstrom, T.
影响因子：
3.3
作者：
Hartlage, SA;Brandenburg, DL;Kravitz, HM
通讯作者：
Kravitz, HM
DOI：
10.1111/j.1552-6909.2006.00051.x
发表时间：
2006-05-01
影响因子：
1.8
作者：
Fehring, RJ;Schneider, M;Raviele, K
通讯作者：
Raviele, K