우울증을 수반한 폐경후기 여성에서 세로토닌재흡수억제제와 단기순차병합 호르몬 대치요법 증강치료의 효과：예비 연구 = The Effectiveness of Short-Term Sequential Combined Hormonal Replacement Therapy Augmentation of Selective Serotonin Reuptake Inhibitor in Postmenopausal Women with Depression：Pilot Study

다국어 초록 (Multilingual Abstract)

Objectives：Estrogen may be useful to manage depression. Some studies have suggested that treatment using
antidepressant medications augmented with estrogen can be more effective than using antidepressant medication
alone. However, data about the estrogen augmentation of selective serotonin reuptake inhibitor (SSRI) medication
is insufficient. We investigated the effect of hormonal replacement treatment (HRT) as an augmentation in
postmenopausal women with depression who were already being treated with SSRIs. Methods：This was an 8-
week prospective, open trial study. The subjects were 13 patients who met the DSM-IV criteria for major
depressive disorder or dysthymia. The menses of all subjects had ceased for at least one year, and all subjects had
serum levels of follicular stimulating hormone (FSH) greater than 40 mIU/mL. All subjects were already taking
sertraline (50-150 mg) or paroxetine (20-30 mg)；during the study they received sequential combined hormone
replacement treatment (1.25 mg estrogen +5 mg medroxyprogesterone). Subjects continued their SSRI medication
at their original dosages throughout the 8-week study. Mood and anxiety symptoms were measured with
the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI). Menopause-related symptoms
were assessed using the Women’s Health Questionnaire (WHQ). Overall clinical symptoms were also assessed
using the Symptom Checklist 90-Revised (SCL-90-R). Serum levels of luteinizing hormone (LH), FSH, prolactin,
estradiol, and progesterone were measured. Measurements were conducted at three times: baseline, four weeks,
and endpoint. Results：The subjects’ mean age was 53.54±5.38 years and mean postmenopausal duration was
4.46±3.67 years. During the HRT, BDI and Trait Anxiety Inventory scores decreased significantly. On the WHQ
subscales, scores for somatic symptoms, vasomotor symptoms, sexual behavior, and sleep problems were
significantly improved. Hormonal levels of LH, FSH, and estradiol changed significantly. Menopausal duration
was significantly correlated with changes in each assessment：somatic symptoms (r=-0.583, p=0.037), anxiety
symptoms (r=-0.623, 0.023), WHQ depressive symptoms (r=-0.586, p=0.035), depression (r=-0.584, p=
0.036), global severity index (r=-0.642, p=0.018), and positive symptom distress index (r=-0.592, p=0.033) of
SCL-90-R. Conclusion：The results suggest that HRT may augment the antidepressant response to SSRIs in
postmenopausal women with depression. The treatment effect of augmentation by HRT seems to be influenced
by menopausal duration. Therefore, further controlled studies should be conducted to test estrogen augmentation
of antidepressants, dependent on the duration of menopause.

국문 초록 (Abstract)

본 연구에서는 단기간의 전향적인 개방 표지 방식으
로 SSRI를 투여 받고 있는 폐경후기 우울증 여성 환자
들에서 호르몬 대체요법을 실시하여 호르몬 농도 변화
및 우울증상과 폐경기 관련 증상들의 변화, 폐경 이후
기간과의 상관성을 조사하였다. DSM-IV에 따라 주요
우울장애나 기분저하증으로 진단을 받았으며, 폐경기간
이 최소 1년 이상이면서 혈중 FSH농도가 40 IU/L를
초과한 13명의 여성이 연구에 등록되었다. 각 연구참가
자는 sertraline(50~150 mg)이나 paroxetine(20~30
mg)을 투여 받고 있었고, 연구기간 동안에는 항우울제
약물의 용량을 고정하여, 8주간 호르몬 대체요법 중 주
기적 estrogen과 progesterone 병합요법 방식을 사용
하였다. BDI, STAI, WHQ, SCL-90-R을 사용하였고,
각 평가는 연구 시작, 4주, 8주 종료 시점에서 이루어졌
다. 본 연구에서는 호르몬 대치요법에 의한 추가적인 항
우울효과가 있는 것으로 나타났다. 본 연구에서는 추가
적 항우울효과의 크기가 폐경기간과 관련성을 보였으며,
폐경기간과 일부 우울척도에서 유의한 부적 상관을 보
인 점으로 보아, 호르몬 대치요법의 효과는 폐경기간의
영향을 받는 것으로 생각된다.

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