不同方法治疗围绝经期及绝经后妇女抑郁症的疗效分析

Comparison of different antidepression therapy in perimenopausal and postmenopausal women with depression

目的探讨抗抑郁药物及性激素治疗围绝经期及绝经后妇女抑郁症的临床效果。方法采用汉米尔顿抑郁量表(HRSD)及自评抑郁量表(SDS)对86例围绝经期及绝经后抑郁症妇女进行抑郁症程度评价,然后随机分为2组,每组43例。对照组应用抗抑郁药物,其中轻、中度(29例)患者应用氟哌噻吨美利曲辛(其他名称:黛力新)1～2片/d;重度患者(14例)应用盐酸氟西汀(其他名称:百忧解)20 mg/d;性激素治疗(HRT)组(轻、中度31例,重度12例)应用替勃龙1.25 mg/d。入选者每4周随访1次,共计12周。结果 (1)有效率:对照组轻、中度抑郁症患者,治疗总有效率为96%;HRT 组治疗总有效率为93%。两组比较,差异无统计学意义(P>0.05)。重度抑郁症的治疗有效率对照组为93%,HRT 组为42%,两组比较,差异有统计学意义(P<0.01)。(2)HRSD 评分:轻、中度抑郁症患者用药前、用药第4、8、12周时,对照组分别为(26.8±5.7)、(10.7±3.6)、(6.4±3.6)、(3.5±2.5)分;HRT 组分别为(25.3±4.7)、(15.2±5.3)、(11.4±4.4)、(4.4±3.8)分。两组内治疗后各时间点 HRSD 评分与治疗前比较,差异均有统计学意义(P<0.01);对照组与 HRT 组用药前及用药第12周时 HRSD 评分比较,差异无统计学意义(P>0.05)。重度抑郁症患者用药前、用药第4、8、12周时,HRSD 评分对照组分别为(37.6±5.6)、(21.4±5.2)、(14.2±4.2)、(7.3±2.3)分;HRT 组分别为(38.2±4.8)、(32.6±5.4)、(28.2±4.6)、(24.3±4.5)分。对照组内治疗后各时间点比较,差异有统计学意义(P<0.01),HRT 组用药前与用药第12周比较,差异也有统计学意义(P<0.05)。两组用药后各时间点 HRSD 评分比较,差异有统计学意义(P<0.01)。(3)SDS 评分:对照组轻、中、重度患者用药前与用药第4、8、12周各时间点 SDS 评分比较,差异均有统计学意义(P<0.01)。HRT 组轻、中度患者用药前与用药第4、8、12周各时间点 SDS 评分比较,差异也有统计学意义(P<0.01);HRT 组重度抑郁症患者用药前与用药第12周比较,差异有统计学意义(P<0.05)。在重度抑郁症患者中,对照组用药后 HRSD、SDS 评分与 HRT 组比较,明显降低,差异有统计学意义(P<0.01)。结论 HRT 可用于治疗围绝经期及绝经后轻、中度抑郁症,对于重度抑郁症患者,抗抑郁药物的治疗效果优于性激素。

Objective To study the effects of antidepression drugs and hormone replacement therapy（HRT） in perimenopausal and postmenopausal women with depression. Methods Eighty six perimenopausal and postmenopansal women with depression were divided into two groups, and treated for 12 weeks, respectively. Forty three received antidepression drugs as control group. Among them, mild to moderate depression were treated with deanxid （ 1 - 2 pills/d ）, and severe depression with fluoxetine （ 20 rag/d）. Another 43 took Tibolone（livial） as HRT group（ 1.25 mg/d）. All patients were assessed with the Hamilton depression rating scale for depression（HRSD） and self rating depression scale（SDS） before and at weeks 4,8,12 after treatment. Results （ 1 ） Total effective rate of control and HRT groups was 96% and 9396, respectively, in mild - moderate depression （X^2 =0.012,P 〉0.05）,while there was a significant difference between two groups in severe depression. The overall effective rates were 93% （ control group）and 42% （ HRT group ）, respectively （ X2 = 5.72, P 〈 0. 01 ）. （ 2 ） HRSD of mild-moderate depression was 26. 8 ± 5.7,10. 7 ± 3.6,6.4 ± 3.6,3. 5 ± 2.5, respectively in control group, and were 25. 3 ± 4. 7,15. 2 ± 5.3,11.4 ± 4. 4,4. 4 ± 3. 8 in HRT group before and at weeks 4,8, and 12 after treatment. There was no difference between two groups at weeks 0, and 12 after treatment （ P 〉 0. 05 ）. HRSD scores of severe depression were 37.6 ± 5. 6,21.4 ± 5. 2,14. 2 ± 4. 2,7.3 ± 2. 3, respectively, in control group, and were 38. 2 ±4. 8, 32. 6 ±5.4,28. 2 ±4. 6,24. 3 ±4. 5, respectively, in HRT group before and at weeks 4,8, and 12 after treatment. There was no difference in HRSD before treatment （ P 〉 0. 05 ）, but a significant difference at weeks 4,8, and 12 between two groups （ P 〈0.01 ）. （ 3 ） SDS of mild and moderate as well as severe depression was significantly different at weeks 0,4. 8, and 12 in control group（P 〈 0. 01 ）, while there was a difference in SDS of severe depression before treatment and at weeks 12 in HRT group （P 〈 0. 05）. A significant reduction in HRSD and SDS of severe depression was demonstrated in control group than in HRT group （ P 〈 0. 01 ） Condusion Antidepression drugs and HRT can improve symptoms of depression in perimenopausal and postmenopausal women, but the effect of antidepression drugs is much better than HRT, especially in severe depression.