更年期抑郁的治疗经验.ppt

HRT SSRI(3) Among patients who were not also taking HT, the response rate to SSRIs was only 63.2%, compared with 83.7% among patients taking HT. Furthermore, the rates of remission were similar for the two groups, at 52.63% and 79.07%, respectively. SR Davis, F Jane - Expert Opinion on Pharmacotherapy, 2010 HRT SSRI (4) They also found that levels of luteinizing hormone (LH) may provide a means of predicting which women are likely to respond GB Mahady - NIH/ODS (Ed.), US NIH, 2010 - SSRI Placebo SSRI are also superior to Placebo Clinical improvement at week 8 (decrease of 50 percent or more from baseline in hot flash frequency) was significantly greater in the escitalopram group than in the placebo group (55 percent vs. 36 percent). Menopause: September/October 2006 - Volume 13 - Issue 5 - pp 780-786 SNRIserotonin and norepinephrine reuptake inhibitors Off-Label Use in Postmenopause Syndrome such as insomnia, anxiety and depression The case of menopausal symptoms, nerve pain, hot flashes and emotional stress are relieved. David F. Archer, Volume 200, Issue 3, March 2009, Pages 238.e1–238.e10 Menopause Terminology: STRAW* Staging System *STRAW = Stages of Reproductive Aging Workshop. ?Stages most likely to be characterized by vasomotor symptoms. Soules MR, et al. Menopause. 2001;8:402-7. Stages: -2 -1 +1 +2 Terminology: Duration of Stage: Menstrual Cycles: Menopausal Transition Postmenopause Early Early? Late? Late Perimenopause Variable Variable cycle length (7 daysdifferent from normal) ?2 skippedcycles and aninterval of amenorrhea(?60 days) 4 yrs Untildemise None 0 Final Menstrual Period 1 yr Amen. × 12 mos. a b Vasomotor symptoms:Why don’t we treat every women with hormones? Menopausal Complaints: Treatments Hormones vs non-hormones vs herbals What kind of herbal drug is effective ? Efficacy ? Clinical Event Hazard Ratio, 95% confidence interval HERS E+P WHI E+P WHI E alone CHD Events 0.99 (0.80-1.22) 1.29 (1.02-1.63) 0.91 (0.75-1.