DEPRESSION AND HYPOGONADISM

重度抑郁症在30-44岁的女性中发病率很高， 在同一年龄段，卵巢生理学的变化是 正在发生。 在最近完成的一项基于人群的病例对照研究中， 我们观察到自我报告的病史与 药物治疗抑郁症和增加提前绝经的风险。 这些 观察提出了一个问题，即抑郁症是否是一种 卵巢功能下降的表现，在停止之前， 时期，或是否严重抑郁症，或其治疗，是一个前兆， 卵巢功能下降的潜在危险因素。 流行病学 建议进行研究，以确认和界定这种关系的性质 重度抑郁症和卵巢功能改变之间的联系 约 将对12，000名年龄在40-44岁之间的女性进行调查， 波士顿地区，以确定一个队列的1,200名绝经前妇女，其中300人， 过去或现在有严重抑郁症史，其中900人没有 目前或过去有严重抑郁症史。 当前和过去的历史 将使用CES-D抑郁来确定重度抑郁 库存，然后使用电话和亲自SCID-P进行验证 精神评估。 所有队列成员都将提前提供基线 卵泡期献血用于FSH和雌二醇，并参与 心理社会、生殖和医学访谈。 前瞻性随访 每6个月一次，为期3年， 献血和随访问卷，以评估 抑郁发作，干预负面生活事件，变化或 药物治疗的引入和月经史的改变。 数据从 将使用逻辑回归方法和考克斯分析该队列 比例风险模型，以测试三个假设：1）主要 抑郁症是卵巢功能下降的前兆和危险因素， 2)抑郁症的药物治疗是一种前兆和风险 卵巢功能下降的因素，3）卵巢功能下降 会导致重度抑郁症 我们还将确定 抑郁症的既往发作次数是否与 FSH的基线水平，以及FSH的变化是否预示 复发性抑郁发作 由于女性在生育后期 2010年是重度抑郁症发病率最高的年份， 患有抑郁症的妇女没有寻求精神病帮助， 是一个重大的公共卫生问题， 收益。 了解重度抑郁症与 卵巢功能下降可能有助于提供有意义的途径， 干预

Major depression occurs with high prevalence in women 30-44 years of age-- the same age period during which changes in ovarian physiology are occurring. In a recently completed population-based case-control study, we observed a significant association between self-reported history of medically treated depression and increased risk of early menopause. These observations raise the question of whether major depression is a manifestation of declining ovarian function that precedes the cessation of periods, or whether major depression, or its therapy, is a precursor and potential risk factor for declining ovarian function. An epidemiologic study is proposed to confirm and define the nature of the relationship between major depression and changes in ovarian function. Approximately 12,000 women between 40-44 years of age will be surveyed in the greater Boston area to identify a cohort of 1,200 premenopausal women, 300 of whom have a past or current history of major depression and 900 of whom have no current or past history of major depression. Current and past history of major depression will be determined with the use of the CES-D depression inventory, and then verified using telephone and inperson SCID-P psychiatric assessments. All cohort members will provide baseline early follicular phase blood donations for FSH and estradiol and participate in psychosocial, reproductive and medical interviews. Prospective followup every 6 months for a period of 3 years will include menstrually timed blood donations, and followup questionnaires to assess onset and offset of depressive episodes, intervening negative life events, changes or introduction of pharmacotherapy, and menstrual history changes. Data from this cohort will be analyzed using logistic regression methods and Cox proportional hazards modelling, to test three hypotheses: 1) major depression is a precursor and risk factor for declining ovarian function, 2) pharmacological treatment for major depression is a precursor and risk factor for declining ovarian function, and 3) declining ovarian function precedes and possibly causes major depression. We will also determine whether number of prior episodes of depression are associated with baseline levels of FSH, and whether changes in FSH are predictive of recurrent depressive episodes. Since women in their late reproductive years have the highest rates of major depression, and close to 40% of women suffering from depression fail to seek psychiatric help, depression is a major public health problem in terms of suffering and foregone earnings. Understanding the relationship between major depression and declining ovarian function may help to provide meaningful avenues of intervention.