DEPRESSION AND HYPOGONADISM

重度抑郁症在30-44岁的女性中发病率很高-- 卵巢生理变化的同一年龄段 发生的。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更年期提前的风险。这些 观察结果提出了一个问题，即严重的抑郁症是否是一种 卵巢功能减退在卵巢功能停止前的表现 周期，或严重抑郁症或其治疗是否是先兆和 卵巢功能下降的潜在危险因素。一种流行病学 建议进行研究，以确认和定义关系的性质 严重的抑郁症和卵巢功能的变化之间的关系。大致 12,000名年龄在40岁至44岁之间的女性将在大都市接受调查 波士顿地区确定了1200名绝经前妇女的队列，其中300人 有过去或现在的严重抑郁症病史，其中900人没有 当前或过去的严重抑郁症病史。现在和过去的历史 重度抑郁症将通过使用CES-D抑郁症来确定 库存，然后使用电话和InPerson SCID-P进行核实 精神评估。所有队列成员将提早提供基线 卵泡期献血FSH和雌二醇并参与 心理社会、生殖和医学面谈。前瞻性随访 为期3年的每6个月将包括月经计时 献血，以及用于评估发病和抵消的后续问卷 抑郁的插曲，介入负面生活事件，改变或 药物治疗的介绍，月经史的变化。数据来自 这一队列将使用Logistic回归方法和COX进行分析 比例风险建模，以检验三个假设：1)主要 抑郁是卵巢功能下降的先兆和风险因素， 2)重度抑郁症的药物治疗是先兆和风险。 卵巢功能下降的因素，以及3)卵巢功能下降 先于并可能导致严重的抑郁症。我们还将确定 既往抑郁发作的次数是否与 FSH的基线水平，以及FSH的变化是否可以预测 反复发作的抑郁发作。因为处于生育后期的女性 严重抑郁症的发病率最高的年份，接近40% 患有抑郁症的女性没有寻求精神帮助，抑郁症 是一个重大的公共卫生问题，就痛苦和放弃而言 收入。了解抑郁症与抑郁症之间的关系 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.