文档介绍：Menopause and DepressionExperience in Treatment
George Linn, MD&PhD
Beijing 2012
Objectives
Menopause associated px
Schizophrenia
Transitional Menopause
Case #2 Test
FSH, E2 and Testosterone
Psychological Consultation
Case #2 Treatment
SNRI for her schizophrenia
Hormone Replacement
Case #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 menopause 10 years ago and has not had any problems except an recurrent depression. She is 5’4”, 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 can’t stand her hot flashes anymore. She can’t sleep 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 , I need some hormones or something.”
Case #4 Treatment
Benzodiazepine
Barbiturate
Hormone Replacement
Tomoxifen ?
Case #5
55 yo BF returns 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 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 are also taking hormonal therapy (HT), Italian researchers suggest.
HRT & 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.
HRT & SSRI(3)
Among patients who were not also taking HT, t