更年期抑郁的治疗经验.pptxVIP

更年期抑郁的治疗经验第1页/共45页 ObjectivesMenopause 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 第2页/共45页 Depression in MenopauseTrend of Suicide in a woman’s LifeTwo peak in all life of womenAdolescence and Menopause Menopause symptom related psychotic disease (Depression) Metabolism, Volume 54, Issue 5, Supplement, May 2005, Pages 49–52第3页/共45页 第4页/共45页 Estrogen with Serotonin 1. Inhibit the Monoamine Oxidase (MAO) function2. Moderate the serotonin (alpha 1) receptor effect Darlene Deechera, From menarche to menopause: Exploring the underlying biology of depression in women experiencing hormonal changes, Psychoneuroendocrinology, Volume 33, Issue 1, January 2008, Pages 3–17 第5页/共45页 第6页/共45页 Serotonin in MenopauseSerotonin decrease it amountSerotonin decrease it effect第7页/共45页 第8页/共45页 第9页/共45页 Estrogen and Depression Premenstrual Dysphoric Disorder (PMDD)Post Partum DepressionPostmenopause Depression第10页/共45页 第11页/共45页 第12页/共45页 第13页/共45页 Six Women and Their Nightmares第14页/共45页 Case #135 yo G1 P0 female presents with c/o hot flashes and amenorrhea for 12 months. She doesn’t know why this is happening, her sex are worsening. Daily work is bothered. Suicide intention and conflict with her husband occurred. She wants your help.第15页/共45页 Case #1 DDxPremature MenopausePituitary TumorsOvarian FailureCerebellum AtrophyIatrogenic Effect 第16页/共45页 Case #1 TestLH, FSH, E2 and TestosteroneSono Examination Brain Computer Tomography第17页/共45页 Case #1 TreatmentHormone ( E+P) (Angeliq) Hot Flush PersistentSSRI (Selective Serotonin Reuptake Inhibitors)Clonidine第18页/共45页 Case #245 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 recent21 yo daughter refused to live with her. DDxTes