Alternative Treatments for Premenstrual Dysphoric Disorder

经前焦虑症的替代治疗

• 批准号: 8839715
• 负责人: BARBARA L PARRY
• 金额: $ 35.27万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-05-01 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8839715
• 关键词: Adverse effects; Affect; Antidepressive Agents; Behavior Therapy; Biological Rhythm; Biology; Chronic; Chronotherapy; Circadian Rhythms; Combined Modality Therapy; Crossover Design; DSM-IV; Depressive disorder; Development; Disease; Early treatment; Family; Health; Intervention; Left; Life; Light; Link; Luteal Phase; Major Depressive Disorder; Malignant neoplasm of ovary; Measures; Melatonin; Menopause; Mental Depression; Mood Disorders; Moods; Outcome; Outcome Measure; Patients; Pharmaceutical Preparations; Pharmacological Treatment; Phase; Phototherapy; Postpartum Period; Pregnancy; Randomized; Relapse; Risk; Safety; Selective Serotonin Reuptake Inhibitor; Sleep; Symptoms; Testing; Time; Translating; Unipolar Depression; Wakefulness; Woman; Women' s Health; Work; alternative treatment; antepartum depression; base; efficacy testing; improved; innovation; intervention effect; malignant breast neoplasm; novel; premenstrual dysphoric disorder; prevent; proliferative phase Menstrual cycle; randomized trial; response; sleep onset; urinary

Innovative, alternative treatments are needed for Premenstrual Dysphoric Disorder (PMDD), a disabling depressive disorder listed in DSM-IV, affecting 5-8% of menstruating women. Left untreated, PMDD can progress to major depression. Offered medication, at least 40% of women do not respond, develop problematic side-effects or seek options other than chronic pharmacological treatment for this periodic illness. Previously we independently administered sleep and light behavioral therapies, translating discoveries from basic circadian biology to improve the health of women with PMDD. In response to a call for the development of novel combination therapies, in this proposal we plan to co-administer wake therapy followed by light treatment, a novel alternative approach, never before tried in PMDD, despite its demonstrated efficacy in other mood disorders. These potentially complementary treatments have the advantage of wake therapy hastening the onset of the antidepressant effects of light treatment, a crucial benefit during the relatively short-lived symptoms of the 2-week luteal phase, whereas light treatment maintains the benefit of the otherwise transitory effects of wake therapy often lost after subsequent sleep. Our primary aim is to examine the effects of these interventions on mood, and secondarily on circadian rhythms, to test the hypothesis that critically-timed chronotherapy improves mood by correcting phase disturbances in melatonin and sleep. As we found that in PMDD melatonin rhythms were phase-delayed (shifted-later) in the symptomatic luteal compared with the asymptomatic follicular, menstrual cycle phase, we hypothesize that advancing melatonin rhythms with late wake therapy (LWT: sleep 21:00-01:00 h, followed by wake) plus morning bright white light (BWL) will improve mood in PMDD patients more than delaying them with early wake therapy (EWT: wake, then sleep 03:00-07:00 h) plus evening BWL. Outcome measures are mood, urinary melatonin, sleep/activity in PMDD subjects. These studies will determine whether innovative, alternative, combined chronobiological interventions, targeted to specific underlying circadian rhythm abnormalities, can benefit mood in PMDD. The results may impact other depressive disorders with chronobiological disturbances and other women¿s mood disorders.

经前焦虑症 (PMDD) 是一种 DSM-IV 中列出的致残性抑郁症，影响 5-8% 的经期女性，需要创新的替代疗法。如果不及时治疗，经前抑郁症可能会发展为重度抑郁症。对于这种周期性疾病，至少 40% 的女性在接受药物治疗后没有反应，出现有问题的副作用，或者寻求慢性药物治疗以外的选择。此前，我们独立实施睡眠和轻度行为疗法，将基本昼夜节律生物学的发现转化为改善患有经前抑郁症的女性的健康。为了响应开发新型联合疗法的号召，在这项提案中，我们计划联合进行唤醒疗法，然后进行光疗，这是一种新颖的替代方法，尽管它在其他情绪障碍中已被证明有效，但以前从未在经前抑郁症中尝试过。这些潜在的补充治疗的优点是，唤醒疗法可以加速光治疗的抗抑郁作用的发挥，这对于两周黄体期相对短暂的症状来说是一个至关重要的好处，而光治疗则保留了唤醒疗法的短暂效果，而这些效果通常在随后的睡眠后消失。我们的主要目的是检查这些干预措施对情绪的影响，其次是对昼夜节律的影响，以检验关键时间疗法通过纠正褪黑激素和睡眠的相位紊乱来改善情绪的假设。我们发现，与无症状的卵泡、月经周期阶段相比，在经前抑郁症 (PMDD) 中，有症状的黄体中的褪黑激素节律存在相位延迟（后移），因此我们推测，通过晚醒治疗（LWT：睡眠 21:00-01:00 小时，然后醒来）加上早晨亮白光 (BWL) 来提前褪黑激素节律，对改善经前抑郁症 (PMDD) 患者情绪的效果会超过 通过早醒治疗（EWT：03:00-07:00 醒来，然后睡觉）加晚间 BWL 来延迟它们。结果测量包括经前抑郁障碍 (PMDD) 受试者的情绪、尿褪黑激素、睡眠/活动。这些研究将确定针对特定的潜在昼夜节律异常的创新、替代、组合时间生物学干预措施是否可以有益于经前抑郁症患者的情绪。研究结果可能会影响其他伴有时间生物学紊乱的抑郁症和其他女性情绪障碍。