更年期抑郁的治疗经验课件.ppt

1、Objectives/Menopause associated psychological changes and symptoms/Pathophysiology in Menopause Depression/Alternative Treatment options for bothersome symptoms(Medications)/Medication for the women who is Contraindicated for Hormone Depression in Menopause/Trend of Suicide in a womans Life/Two peak

2、 in all life of women/Adolescence and Menopause/Menopause symptom related psychotic disease(Depression)Metabolism,Volume 54,Issue 5,Supplement,May 2019,Pages 4952Estrogen with Serotonin/1.Inhibit the Monoamine Oxidase (MAO)function/2.Moderate the serotonin(alpha 1)receptor effect Darlene Deechera,Fr

3、om menarche to menopause:Exploring the underlying biology of depression in women experiencing hormonal changes,Psychoneuroendocrinology,Volume 33,Issue 1,January 2019,Pages 317 Serotonin in Menopause/Serotonin decrease it amount/Serotonin decrease it effectEstrogen and Depression/Premenstrual Dyspho

4、ric Disorder(PMDD)/Post Partum Depression/Postmenopause Depression Six Women and Their NightmaresCase#1/35 yo G1 P0 female presents with c/o hot flashes and amenorrhea for 12 months.She doesnt know why this is happening,her sex are worsening.Daily work is bothered.Suicide intention and conflict with

5、 her husband occurred.She wants your help.Case#1 DDx/Premature Menopause/Pituitary Tumors/Ovarian Failure/Cerebellum Atrophy/Iatrogenic Effect Case#1 Test/LH,FSH,E2 and Testosterone/Sono Examination/Brain Computer TomographyCase#1 Treatment/Hormone(E+P)(Angeliq)/Hot Flush Persistent/SSRI(Selective S

6、erotonin Reuptake Inhibitors)/ClonidineCase#2/45 yo G2 P2 female presents with c/o hot flashes and irregular menses(q 3-5 mos)for the past 9 months.Body weight gained in recent.Her mood and behavior change./Family Abuse in recent/21 yo daughter refused to live with her./DDx/TestsCase#2 DDx/Schizophr

7、enia/Transitional Menopause Case#2 Test/FSH,E2 and Testosterone/Psychological ConsultationCase#2 Treatment/SNRI for her schizophrenia/Hormone ReplacementCase#3/65 yo WF presents to start HRT.She heard it would help protect her heart,make her feel younger and help her memory.She went through menopaus

8、e 10 years ago and has not had any problems except an recurrent depression.She is 54”,108 lbs.By the way,she had a wrist fx 2 yrs ago takes her evista faithfully.Case#3 Treatment/Prozac or not?/Tricyclic antidepresents?Case#4/49 yo WF presence b/c she cant stand her hot flashes anymore.She cant slee

9、p very well b/c she wakes up 3 times a night drenched with sweat.She is an executive at First National Bank.She has a history of breast cancer 2 years ago.“Please Dr.Linn,I need some hormones or something.”Case#4 Treatment/Benzodiazepine/Barbiturate/Hormone Replacement/Tomoxifen?Case#5/55 yo BF retu

10、rns to discuss stopping her HRT.She has been taking it for 5 years now with good relief of her vasomotor and sexs.After discontinuing her HRT,she was involved with slight depression and chronic pain.Case#6/53 yo breat cancer woman stage 1 began continuous tomoxifen for 4 years.She is now having some

11、 vaginal spotting.After using the aromatase inhibit,severe insomnia and disorder bother her.Case#6 Treatment/Hystectomy/Regain Tomoxifen/Stop Aromatase Inhibitor/SSRI or SNRI HRT or SSRI(1)/Postmenopausal women with depression respond better to selective serotonin reuptake inhibitors(SSRIs)if they a

12、re also taking hormonal therapy(HT),Italian researchers suggest./E Hall,BN Frey,CN Soares-Drugs,2019-ingentaconnectHRT&SSRI(2)/Random Control,No response to SSRIs in 170 postmenopausal women with a depressive episode,as defined by the DSM-IV criteria,47 of whom were on HT./E Hall,BN Frey,CN Soares-D

13、rugs,2019-ingentaconnectHRT&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

14、Pharmacotherapy,2019 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,2019-ods.od.nih.govSSRI&Placebo/SSRI are also superior to Placebo/Clinical improvement at week 8(decrease of 50 per

15、cent 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 2019-Volume 13-Issue 5-pp 780-786SNRIserotonin and norepinephrine reuptake inhibitors/Off-Label Use in Postmenopause

16、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.e1238.e10Menopause Terminology:STRAW*Staging System*STRAW=Stages of Reproductive Aging Workshop.Stages mos

17、t likely to be characterized by vasomotor symptoms.Soules MR,et al.Menopause.2019;8:402-7.Terminology:Duration of Stage:Menstrual Cycles:Final Menstrual PeriodVasomotor symptoms:Why dont we treat every women with hormones?Menopausal Complaints:Treatments/Hormones vs non-hormones vs herbals/What kind

18、 of herbal drug is effective?/Efficacy?Clinical EventHazard Ratio,95%confidence intervalHERS E+PWHI E+PWHI E aloneCHD Events0.99(0.80-1.22)1.29(1.02-1.63)0.91(0.75-1.12)Stroke1.23(0.89-1.70)1.41(1.07-1.85)1.39(1.10-1.77)Pulm.Embolism2.79(0.89-8.75)2.13(1.39-3.25)1.34(0.87-2.06)Breast Cancer1.30(0.77

19、-2.19)1.26(1.00-1.59)0.77(0.59-1.01)Colon Cancer0.69(0.32-1.49)0.63(0.43-0.92)1.08(0.75-1.55)Hip Fracture1.10(0.49-2.50)0.66(0.45-0.98)0.61(0.41-0.91)Death1.08(0.84-1.38)0.98(0.82-1.18)1.04(0.88-1.22)Global Index-1.15(1.03-1.28)1.01(0.89-1.70)Hormones Contraindicated/Breast CA/Endometrial CA/Undiagn

20、osed vaginal bleeding/CHD/Venous thrombosis/Stroke/Pregnancy/What is not here,that is a CI on OCPs?Specific Geriatric IssuesOther assessments to be made.Cognitive Function/Normal decline/Dementia/Alzheimers/Vascular/Others/Depression/Medications/EtOH/MMSESensory/Visual/Auditory/BalancePolypharmacy/Medication List/Drug-drug interactions/Altered pharmacokinetics,pharmacodynamics/Herbals/OTC