Effects of gonadal steroids in women with a history of postpartum depression
Effects of gonadal steroids in women with a history of postpartum depression
复制标题
DOI：
10.1176/appi.ajp.157.6.924
复制
发表时间：
2000-06-01
影响因子：
17.7
通讯作者：
Rubinow, DR
中科院分区：
文献类型：
--
作者：
Bloch, M;Schmidt, PJ;Rubinow, DR
目的：内分泌因素被认为在产后抑郁症的病因中起作用，但缺乏直接证据证明这一作用。作者通过模拟有和没有产后抑郁症病史的两种与妊娠和分娩相关的荷尔蒙状况，研究了性腺类固醇水平变化在产后抑郁症中的可能作用。方法：通过用促性腺激素释放激素激动剂醋酸亮丙内酯，在双盲条件下，通过诱导性腺功能低下的女性(8名有产后抑郁症病史和8名没有产后抑郁症病史)，模拟怀孕和退出高水平性腺激素状态的性腺激素水平，然后在双盲条件下停用这两种类固醇。结果：有产后抑郁症病史的8例中有5例(62.5%)在停药期间出现明显的情绪症状，对照组8例中无一例出现明显的情绪症状，重复测量每日和横断面情绪评分的方差分析显示逐组效应显著。与基线相比，这些效应反映了有产后抑郁症病史的妇女抑郁症状的显著增加，但在激素停用后(以及激素替代阶段结束时)，对照组没有明显的抑郁症状。结论：这些数据为生殖激素雌激素和孕酮参与了一部分妇女产后抑郁的发生提供了直接证据。此外，他们还表明，有产后抑郁症病史的女性对性腺类固醇对情绪不稳定的影响具有不同的敏感性。
Objective: Endocrine factors are purported to play a role in the etiology of postpartum depression, but direct evidence for this role is lacking. The authors investigated the possible role of changes in gonadal steroid levels in postpartum depression by simulating two hormonal conditions related to pregnancy and parturition in euthymic women with and without a history of postpartum depression.Method: The supraphysiologic gonadal steroid levels of pregnancy and withdrawal from these high levels to a hypogonadal state were simulated by inducing hypogonadism in euthymic women-eight with and eight without a history of postpartum depression-with the gonadotropin-releasing hormone agonist leuprolide acetate, adding back supraphysiologic doses of estradiol and progesterone for 8 weeks, and then withdrawing both steroids under double-blind conditions. Outcome measures were daily symptom self-ratings and standardized subjective and objective cross-sectional mood rating scales.Results: Five of the eight women with a history of postpartum depression (62.5%) and none of the eight women in the comparison group developed significant mood symptoms during the withdrawal period, analysis of variance with repeated measures of daily and cross-sectional ratings of mood showed significant phase-by-group, effects. These effects reflected significant increases in depressive symptoms in women with a history of postpartum depression hut not in the comparison group after hormone withdrawal (and during the end of the hormone replacement phase), compared with baseline.Conclusions: The data provide direct evidence in support of the involvement of the reproductive hormones estrogen and progesterone in the development of postpartum depression in a subgroup of women. Further, they suggest that women with a history of postpartum depression are differentially sensitive to mood-destabilizing effects of gonadal steroids.