Systematic review and meta-analysis of the effects of progestins on depression in post-menopausal women: An evaluation of randomized clinical studies that used validated questionnaires

IF 4.3 3区 材料科学 Q1 ENGINEERING, ELECTRICAL & ELECTRONIC
Ambrogio P. Londero , Veronica Gallina , Francesca Cremonini , Anjeza Xholli , Angelo Cagnacci
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引用次数: 0

Abstract

Objective

Hormone therapy (HT) can relieve symptoms of menopause and treat chronic diseases. Its effectiveness in treating psychological symptoms is still debated. Several progestins can be used in HT, but their effects on mood, in particular depressive symptoms, is still unclear. This systematic review evaluates the evidence from randomized clinical trials with postmenopausal women on the effect of adjunctive progestins on symptoms of depression assessed by validated questionnaires. The primary aim was to evaluate scores on the Center for Epidemiologic Studies Depression Scale (CESD). The secondary aim was to assess scores on the Beck Depression Inventory (BDI), the Hamilton Depression Rating Scale (HAMD), and the Zung Self-Rating Depression Scale (SDS).

Methods

A systematic review and meta-analysis were conducted to identify the most reliable evidence of the effects of progestin on depression to inform decision-making. A PICO- and PRISMA-based framework was established to formulate explicit and reasoned recommendations. The pre-/post-treatment effect was evaluated using standardized mean change (SMC).

Results

We selected and analyzed 16 randomized clinical trials qualitatively and 12 studies quantitatively out of 9320 items identified. Most of the studies used medroxyprogesterone acetate as progestin. The results indicate that depressive symptoms do not increase with the addition of a progestin to estrogen HT. Depressive symptoms improved over time in the progestins-estrogen HT group, independent of progestin type (SMC CES-D −0.08 CI.95–0.10/−0.06, BDI −0.19 CI.95–0.32/−0.06, HAM-D −1.13 CI.95–1.47/−0.78, and SDS −0.11 CI.95–0.82/0.60). Yet similar effects were observed with estrogens alone and did not significantly differ from control groups on placebo. In one study, the addition of fluoxetine greatly increased the reduction of depressive symptoms observed with estrogen-progestin HT.

Conclusions

In summary, in randomized clinical trials using validated questionnaires adjunctive progestin with estrogens did not increase depressive symptoms of postmenopausal women. Overall, depressive symptoms decreased with estrogen-progestin HT but also with estrogen alone. The decrease was not so pronounced to differ from controls on placebo. HT does not hamper the clinical efficacy of fluoxetine. The scarcity of randomized studies makes it difficult to determine the exact effect on depressive symptoms of different types of progestins.

Project protocol registered in PROSPERO, registration number CRD42023454099.

孕激素对绝经后妇女抑郁症影响的系统回顾和荟萃分析:对使用有效问卷的随机临床研究进行评估
目的 激素疗法(HT)可以缓解更年期症状,治疗慢性疾病。但它对心理症状的治疗效果仍存在争议。有几种孕激素可用于激素治疗,但它们对情绪,尤其是抑郁症状的影响仍不明确。本系统性综述评估了以绝经后妇女为研究对象的随机临床试验的证据,这些试验通过有效问卷评估了辅助性孕激素对抑郁症状的影响。主要目的是评估流行病学研究中心抑郁量表(CESD)的得分。次要目的是评估贝克抑郁量表 (BDI)、汉密尔顿抑郁评定量表 (HAMD) 和 Zung 抑郁自评量表 (SDS) 的得分。方法进行了系统综述和荟萃分析,以确定孕激素对抑郁症影响的最可靠证据,为决策提供依据。建立了基于 PICO 和 PRISMA 的框架,以提出明确合理的建议。结果我们从已确定的 9320 个项目中筛选并定性分析了 16 项随机临床试验,定量分析了 12 项研究。大多数研究使用醋酸甲羟孕酮作为孕激素。结果表明,在雌激素 HT 中添加孕激素不会增加抑郁症状。随着时间的推移,孕激素-雌激素 HT 组的抑郁症状有所改善,这与孕激素类型无关(SMC CES-D -0.08 CI.95-0.10/-0.06、BDI -0.19 CI.95-0.32/-0.06、HAM-D -1.13 CI.95-1.47/-0.78、SDS -0.11 CI.95-0.82/0.60)。然而,单独使用雌激素也能观察到类似的效果,而且与使用安慰剂的对照组没有明显差异。结论综上所述,在使用有效问卷的随机临床试验中,孕激素与雌激素的辅助治疗并未增加绝经后妇女的抑郁症状。总体而言,使用雌激素-孕激素 HT 和单独使用雌激素时,抑郁症状都有所减轻。与服用安慰剂的对照组相比,抑郁症状的减少并不明显。孕激素抑制剂不会妨碍氟西汀的临床疗效。由于缺乏随机研究,因此很难确定不同类型的孕激素对抑郁症状的确切影响。项目方案已在 PROSPERO 注册,注册号为 CRD42023454099。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.20
自引率
4.30%
发文量
567
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