Alternative Treatments for Premenstrual Dysphoric Disorder

经前焦虑症的替代治疗

基本信息

批准号：
9267940
负责人：
BARBARA L PARRY
金额：
$ 35.78万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN DIEGO
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-05-01 至 2018-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9267940
关键词：
Adverse effects Affect Antidepressive Agents Behavior Therapy Biological Rhythm Biology Chronic Chronotherapy Circadian Rhythms Combined Modality Therapy Crossover Design DSM-IV Depressive disorder Development Disease Family Health Impairment Intervention Left Light Link Luteal Phase Major Depressive Disorder Malignant neoplasm of ovary Measures Melatonin Menopause Menstrual cycle Mental Depression Mood Disorders Moods Outcome Outcome Measure Patients Periodicity Pharmaceutical Preparations Pharmacological Treatment Pharmacology Phase Phototherapy Postpartum Period Pregnancy Randomized Relapse Risk Safety Selective Serotonin Reuptake Inhibitor Sleep Symptoms Testing Time Translating Unipolar Depression Wakefulness Woman Women&apos s Health Work alternative treatment antepartum depression antidepressant effect base efficacy testing improved innovation intervention effect malignant breast neoplasm multimodality novel premenstrual dysphoric disorder prevent randomized trial response sleep onset treatment effect treatment response urinary

项目摘要

Innovative, alternative treatments are needed for Premenstrual Dysphoric Disorder (PMDD), a disabling depressive disorder listed in DSM-IV, affecting 5-8% of menstruating women. Left untreated, PMDD can progress to major depression. Offered medication, at least 40% of women do not respond, develop problematic side-effects or seek options other than chronic pharmacological treatment for this periodic illness. Previously we independently administered sleep and light behavioral therapies, translating discoveries from basic circadian biology to improve the health of women with PMDD. In response to a call for the development of novel combination therapies, in this proposal we plan to co-administer wake therapy followed by light treatment, a novel alternative approach, never before tried in PMDD, despite its demonstrated efficacy in other mood disorders. These potentially complementary treatments have the advantage of wake therapy hastening the onset of the antidepressant effects of light treatment, a crucial benefit during the relatively short-lived symptoms of the 2-week luteal phase, whereas light treatment maintains the benefit of the otherwise transitory effects of wake therapy often lost after subsequent sleep. Our primary aim is to examine the effects of these interventions on mood, and secondarily on circadian rhythms, to test the hypothesis that critically-timed chronotherapy improves mood by correcting phase disturbances in melatonin and sleep. As we found that in PMDD melatonin rhythms were phase-delayed (shifted-later) in the symptomatic luteal compared with the asymptomatic follicular, menstrual cycle phase, we hypothesize that advancing melatonin rhythms with late wake therapy (LWT: sleep 21:00-01:00 h, followed by wake) plus morning bright white light (BWL) will improve mood in PMDD patients more than delaying them with early wake therapy (EWT: wake, then sleep 03:00-07:00 h) plus evening BWL. Outcome measures are mood, urinary melatonin, sleep/activity in PMDD subjects. These studies will determine whether innovative, alternative, combined chronobiological interventions, targeted to specific underlying circadian rhythm abnormalities, can benefit mood in PMDD. The results may impact other depressive disorders with chronobiological disturbances and other women�s mood disorders.

经前焦虑症 (PMDD) 是一种 DSM-IV 中列出的致残性抑郁症，如果不接受治疗，PMDD 可能会发展为重度抑郁症（至少 40%），因此需要创新的替代疗法。的女性没有反应，出现有问题的副作用或寻求除慢性药物治疗之外的其他选择来治疗这种周期性疾病。此前，我们独立进行了睡眠和轻度行为疗法，转化了基本发现。昼夜节律生物学可改善经前抑郁症女性的健康为了响应开发新型联合疗法的呼吁，在本提案中，我们计划联合进行唤醒疗法和光治疗，这是一种以前从未在经前抑郁症中尝试过的新型替代方法。尽管它已被证明对其他情绪障碍有效，但这些潜在的补充疗法具有唤醒疗法的优点，可以加速光疗法的抗抑郁作用的发挥，这对于两周黄体期相对短暂的症状来说是一个至关重要的好处，而光处理保持清醒疗法在随后的睡眠后通常会失去的短暂效果的益处，我们的主要目的是检查这些干预措施对情绪的影响，其次是对昼夜节律的影响，以检验关键定时时间疗法通过纠正情绪来改善情绪的假设。我们发现，与无症状的人相比，经前抑郁症患者的褪黑激素节律在有症状的黄体中出现相位延迟（后移）。在卵泡期、月经周期阶段，我们认为通过晚醒疗法（LWT：21:00-01:00 睡眠，然后醒来）加上早晨明亮的白光 (BWL) 来推进褪黑激素节律比延迟更能改善 PMDD 患者的情绪他们接受早醒疗法（EWT：醒来，然后在 03:00-07:00 睡觉）加上晚间 BWL，结果指标包括情绪、尿褪黑素、这些研究将确定针对特定的潜在昼夜节律异常的创新、替代、组合时间生物学干预措施是否可以有益于经前抑郁症患者的情绪。这些结果可能会影响其他伴有时间生物学紊乱的抑郁症和其他女性情绪障碍。