Estrogen deficiency in severe postpartum depression:: Successful treatment with sublingual physiologic 17β-estradiol:: A preliminary study
Estrogen deficiency in severe postpartum depression:: Successful treatment with sublingual physiologic 17β-estradiol:: A preliminary study
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DOI：
10.4088/jcp.v62n0504
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发表时间：
2001-05-01
影响因子：
5.3
通讯作者：
Aito, M
中科院分区：
文献类型：
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作者：
Ahokas, A;Kaukoranta, J;Aito, M
背景：产后时期是女性易患抑郁症的阶段，抑郁症可能很严重且具有长期不良后遗症。尽管与医疗服务提供者有多次接触，但产后抑郁症女性往往仍未被识别和治疗。为了评估雌二醇与产后抑郁症之间的关联，我们测量了血清雌二醇浓度，并对生理性17β - 雌二醇进行了一项开放标签研究。
方法：从精神科急诊室连续招募了23名符合《国际疾病分类第10版》（ICD - 10）产后发作的重度抑郁症标准的女性。在基线时以及舌下含服17β - 雌二醇治疗8周期间每周测量血清雌二醇浓度。使用临床医生评定的抑郁症状量表——蒙哥马利 - 阿斯伯格抑郁评定量表（MADRS）对治疗进行评估。
结果：在基线时，所有患者都患有重度抑郁症（平均MADRS总分 = 40.7；范围，35 - 45），且血清雌二醇浓度较低（平均 = 79.8 pmol/L；范围，23 - 140 pmol/L）；在23名患者中的16名患者中，该浓度甚至低于性腺功能衰竭的阈值。在雌二醇治疗的第一周，抑郁症状显著减轻，导致平均MADRS评分为11.0（Z = - 4.20，p <.001），并且血清雌二醇浓度接近卵泡期水平（平均±标准差 = 342 ± 141 pmol/L）。在治疗的第二周结束时，23名患者中的19名患者的MADRS评分符合临床康复标准。
结论：这项初步研究表明，通过17β - 雌二醇治疗，有雌二醇缺乏记录的产后抑郁症患者的抑郁症状可能会迅速减轻，并提示雌二醇在这种疾病的病理生理学中具有重要意义，可能是治疗易患产后抑郁症女性的一种选择。
Background: The postpartum period is a time when women are vulnerable to depressive disorders, which can be severe and have long-lasting adverse sequelae. In spite of multiple contacts with health care providers, women with postpartum depression often remain unrecognized and untreated. To evaluate the association between estradiol and postpartum depression, we measured serum estradiol concentration and performed an open-label study of physiologic 17 beta -estradiol.Method: Twenty-three women fulfilling ICD-10 criteria for major depression with postpartum onset were consecutively recruited from a psychiatric emergency unit. Serum estradiol concentrations were measured at baseline and weekly during sublingual 17 beta -estradiol treatment for 8-weeks. The treatment was assessed using a clinician-rated depression symptom scale, the Montgomery-Asberg Depression Rating Scale (MADRS).Results: At baseline, all patients were severely depressed (mean MADRS total score = 40.7; range, 35-45) and had a low serum estradiol concentration (mean = 79.8 pmol/L; range, 23-140 pmol/L); in 16/23 patients, the concentration was even lower than the threshold value for gonadal failure. During the first week of estradiol treatment, depressive symptoms diminished significantly, resulting in a mean MADRS score of 11.0 (Z = -4.20, p < .001), and serum estradiol concentrations approached those of the follicular phase (mean +/- SD = 342 +/- 141 pmol/L). At the end of the second week of treatment, the MADRS scores were compatible with clinical recovery in 19/23 patients.Conclusion: This preliminary study shows that depression symptoms may be rapidly reduced in patients with postpartum depression who have documented estradiol deficiency by treatment with 17 beta -estradiol and suggests that estradiol can have significance in the pathophysiology of this condition and may be an option in the treatment of women vulnerable to postpartum depression.