口服避孕药缓解女性经前抑郁
纽约（路透社健康专栏） 1月18日——患有抑郁症的女性在月经前数天常有情绪症状加重，一项最新研究表明，在抗抑郁药物的基础上加用一种口服避孕药可以使其症状缓解。该研究结果发表在12月份出版的《The Journal of Clinical Psychiatry》杂志。
美国马萨诸塞州总医院和哈佛医学院的Hadine Joffe博士和同事们在这项研究中共纳入25名治疗顺利的抑郁症患者，排除处于黄体晚期和黄体极晚期后，在月经周期的前21天接受包括雌二醇（EE， 30克/日）和屈螺酮（DRSP， 3毫克/日）的开放式口服避孕药治疗；月经周期的后7天（也就是第 2 2日至2 8日）则进行随机双盲治疗，分别给予EE3 0克/天（ n=12）或安慰剂（ n = 13 ） ，共两个月经周期。在完成研究的21名妇女中，两组患者的经前抑郁水平均较基线水平明显改善，两组之间的结果并无显著差异。
研究人员总结说，这项研究为"当给予21/7天的OCP（口服避孕药）标准疗法时，不论雌二醇是否连续给药，这种包含EE/DRSP或其他OCP的强化抗抑郁治疗都可以改善经前抑郁加重“提供了初步证据。最初研究者认为“通过稳定整月的雌二醇水平，在传统的激素间歇期连续使用乙炔雌二醇会使患者获得额外受益”，但研究结果并不支持他们的假设。
Joffe博士在给路透社健康专栏的一封电子邮件中指出， "已接受抗抑郁剂治疗的女性服用OCP后抑郁加重的情况非常罕见。为了达到最佳治疗效果，抑郁妇女使用OCP应该是一个值得考虑的方法" 。
原文：NEW YORK (Reuters Health) Jan 18 - Women with treated depression whose mood symptoms break through in the days before menstruation benefit from the addition of an oral contraceptive to antidepressants, research indicates.
In a study reported in the December issue of the Journal of Clinical Psychiatry, 25 women with successfully treated depression, except during the late luteal phase and the high-late luteal phase, were assigned to open-label treatment with an oral contraceptive containing ethinyl estradiol (EE; 30 g/day) plus drospirenone (DRSP; 3 mg/day) for 21 days; for the remaining 7 days of their cycle -- days 22 through 28 -- they were randomized to double-blind treatment with EE 30 g/day (n = 12) or placebo (n = 13). The protocol was followed for two menstrual cycles.
Among the 21 women who completed the study, premenstrual depression levels improved significantly from baseline in both groups and outcome did not differ between the groups, Dr. Hadine Joffe and colleagues from Massachusetts General Hospital and Harvard Medical School, Boston, found.
This study "provides preliminary evidence that augmentation of antidepressants with an OCP (oral contraceptive pill) containing EE/DRSP and potentially other OCPs improves depression symptoms that break through premenstrually when the OCP is administered in a standard 21/7-day regimen with or without continuous estradiol administration," they conclude.
The results do not support their hypothesis that continuous use of EE during the traditional hormone-free interval would confer additional therapeutic benefit by stabilizing levels of estradiol throughout the month, they also note.
In an e-mail to Reuters Health, Dr. Joffe noted that "worsening of depression on an OCP in depressed women treated with an antidepressant is rare. Use of an OCP in these women should be an important consideration for optimizing their treatment."
J Clin Psychiatry 2007;68:1954-1962.
