Цель

ssmu

Бюллетень сибирской медицины

Bulletin of Siberian Medicine

1682-03631819-3684

Siberian State Medical University, the Ministry of Healthcare of the Russian Federation

10.20538/1682-0363-2018-2-100-113

ssmu-1208

Research Article

ОБЗОРЫ И ЛЕКЦИИ

REVIEW AND LECTURES

Депрессивные расстройства у женщин в климактерическом возрасте (обзор зарубежной литературы за 2012–2016 гг.)

Depressive disorders in women of climacteric age (review of foreign literature for 2012–2016)

Бохан

Н. А.

Bokhan

N. A.

д-р мед. наук, профессор, академик РАН, заслуженный деятель науки РФ, директор НИИ ПЗ, 634050, г. Томск, Московский тракт, 2;

Россия, 634014, г. Томск, ул. Алеутская, 4

DM, Рrofessor, Аcademician of RAS, Honored Scientist of the Russian Federation, Director of Mental Health Research Institute, 4, Aleutskaya Str., 634014, Tomsk;

2, Moskow Trakt, 634050, Tomsk

Лукьянова

Е. В.

Lukiyanova

E. V.

канд. мед. наук, врач высшей категории, зав. третьим клиническим психиатрическим отделением,

634050, г. Томск, Московский тракт, 2

PhD, Doctor, Head of the 3rd Clinical Psychiatric Unit, Mental Health Research Institute,

4, Aleutskaya Str., 634014, Tomsk

lucyanova0804@sibmail.com

Симуткин

Г. Г.

Simutkin

G. G.

д-р мед. наук, вед. науч. сотрудник, отделение аффективных состояний,

634050, г. Томск, Московский тракт, 2

DM, Lead Researcher, Affective States Department, Mental Health Research Institute,

4, Aleutskaya Str., 634014, Tomsk

Научно-исследовательский институт психического здоровья (НИИ ПЗ), Томский национальный исследовательский медицинский центр (ТНИМЦ) Российской академии наук (РАН); Сибирский государственный медицинский университет (СибГМУ)РоссияMental Health Research Institute, Tomsk National Research Medical Center (TNRMC), Russian Academy of Sciences (RAS); Siberian State Medical University (SSMU)Russian Federation

Научно-исследовательский институт психического здоровья (НИИ ПЗ), Томский национальный исследовательский медицинский центр (ТНИМЦ) Российской академии наук (РАН)РоссияMental Health Research Institute, Tomsk National Research Medical Center (TNRMC), Russian Academy of Sciences (RAS)Russian Federation

2018

20072018

172100113

2018

Бохан Н.А., Лукьянова Е.В., Симуткин Г.Г.

Bokhan N.A., Lukiyanova E.V., Simutkin G.G.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://bulletin.ssmu.ru/jour/article/view/1208

Цель

Цель: обзор зарубежной периодики с интерпретацией результатов.

Задачи

Задачи: обзор зарубежных работ, в которых рассматриваются провоцирующие развитие депрессии факторы: гормональный, психологический, социальный, а также нейромедиаторные, гормональные и иммунные нарушения при депрессивных расстройствах у женщин с физиологическим климактерием и климактерическим синдромом; дифференциальная диагностика, психофармако- и психотерапия депрессий с оценкой клинической эффективности; личностный профиль пациентов с аффективной психопатологией.

Методы поиска

Методы поиска: по ключевым словам в базе данных Web of Science Core Collection по зарубежным журналам (2012–2016 гг.).

Критерии включения статей в обзор: 1) женщины климактерического возраста; 2) депрессии или депрессивные симптомы; 3) климактерические нарушения. В реферативно-библиографической наукометрической базе Web of Science Core Collection по зарубежным журналам, в том числе с высоким импакт-фактором, выбрано 70 библиографических источников. Вошедшие в обзор исследования выполнены в университетских клиниках, специализированных центрах. Клинические и социально-демографические характеристики отвечают критерию сопоставимости. Большинство работ посвящено изучению клинических и социально-психологических факторов развития климактерической депрессии (КД). В ряде работ показана эффективность антидепрессивной терапии, альтернативных методов, дополнительного лечения у женщин с депрессивными расстройствами, климактерическими нарушениями и сопутствующими соматическими заболеваниями. Преобладают исследования, выполненные с привлечением анкетного опроса (социально-демографические данные, анамнез) и международных клинических шкал. Основные результаты обсуждаемых статей изложены в тематических рубриках.

Заключение

Заключение. С большей частотой встречаются европейские и американские работы, реже – из стран Азии. Публикации отражают мировую тенденцию к росту КД в женской популяции с наличием в анамнезе депрессии подростковой и послеродовой, предменструального синдрома. Отмечаются низкая своевременная диагностика депрессий, высокая встречаемость соматизированной КД. В структуре климактерического синдрома психоэмоциональные нарушения преобладают над нейровегетативными и обменно-эндокринными либо сочетаются с вегетативной дисфункцией. В формировании КД участвуют нейрогормональные, генетические, биохимические, социально-средовые, психологические факторы. При КД описаны угнетенное настроение, утрата жизненных приоритетов, снижение работоспособности и концентрации внимания, незащищенность, несамостоятельность, неуверенность, самоуничижение, раскаяние, неверие в будущее, инсомнии, гипо- и гиперрексия, но отсутствуют публикации по суицидальной настроенности. КД может протекать с истеро- и нозофобическим, соматоипохондрическим или астеноневротическим компонентом. Соматизация как переживание климактерического стресса приводит к соматизированной КД с акцентом на соматические симптомы и вытеснением депрессии и тревоги, хотя не описано ассоциированности конкретных соматических нозологий с КД. Обсуждается связь КД с социально-средовыми факторами (пол, образование, профессия, положение, финансовая состоятельность). Интерес авторов в развитии КД вызывает поиск генетических маркеров, нарушения нейромедиаторного обмена, нейроморфологические изменения в сенсомоторной коре головного мозга, гормональные и психонейроиммунологические нарушения. Психофармакотерапия при КД учитывает депрессивную симптоматику (антидепрессанты активизирующего и (или) седативного действия в длительном режиме), сопутствующие заболевания (патогенетическая и иммунотерапия, заместительная гормонотерапия эстрогеном, прогестероном). Обсуждается альтернативное лечение КД. Для повышения эффективности и безопасности лечения КД предлагается научение распознаванию признаков КД самих пациентов, медицинских работников, психологов, социальных работников.

Objective

Objective: to systematically review foreign literature and interpret results of the review. Tasks: to review foreign papers where factors are considered which provoke development of depression: hormonal, psychological, social as well as neuromediators, hormonal and immune disturbances in depressive disorders in women with physiological climacteric and climacteric syndrome; issues of differential diagnostics of depressions, psychopharmaco- and psychotherapy with subsequent evaluation of clinical efficiency; personality profile of pateints with affective psychopathology.

Methods of search

Methods of search: by keywords in Web of Science Core Collection database across foreign journals (2012– 2016). Criteria of inclusion of papers in the review are determined by themes of studies: 1) women of climacteric age; 2) presence of depression or depressive symptoms; 3) presence of climacteric disturbances. In the abstract-bibliographic and scientometric database Web of Science Core Collection 70 bibliographic sources are selected across foreign journals between 2012 and 2016, including journals with high Impact Factor. Studies included in the review are performed at the university clinics, specialized centers. Clinical and sociodemographic characteristics of female patients meet the criterion of compatibility. Most discussed papers are devoted to study of clinical and social-psychological factors of development of climacteric depression. In a number of papers the efficiency of antidepressant therapy, alternative methods and supplementary therapy in women with depressive disorders, climacteric disturbances and co-occurring physical diseases is shown. Most works are performed with involvement of questionnaires (sociodemographic data, anamnesis) and international clinical scales. The main results of the discussed papers are outlined in thematic rubrics.

Conclusion

Conclusion. The European and American papers are used in this review more frequently; studies from Asian countries are used more seldom. Reviewed foreign publications reflect worldwide trend to increase of climacteric depression (CD) in the female population with presence in the anamnesis of adolescent (psychoendocrine alteration) and postpartum depression, premenstrual syndrome. Low timely diagnostics of depressions, high incidence rate of somaticized CD are noted. In the structure of climacteric syndrome the psychoemotional disturbances predominate above neurovegetative and metabolic-endocrine or are combined with vegetative dysfunction. The participation in formation of CD (with predominance of mild/moderate severity) of neurohormonal, genetic, biochemical, social-environmental, psychological factors is shown. In the reviewed sources low mood, loss of previous priorities, decrease of productivity and concentration of attention, position of being unprotected, dependence, lack of confidence, self-humiliation, repentance, unbelief in future, insomnias, hypo-/hyperrexia with change of body mass are described in CD but there are no publications on suicidal ideation. It is indicated that CD can flow with hysteric- and nosophobic, somatohypochondriac and asthenohypochondriac component. The authors consider that somatization as an experience of climacteric stress leads to somaticized CD with accent on physical symptoms and repression of depression and anxiety although an association of specific somatic nosologies with symptoms of CD is not described. The association of CD with social-environmental factors (gender, education, profession, social position, financial wealth) is discussed, achievement of the woman is considered as a actor of reduction of CD risk. The authors are highly interested in search for genetic markers (heredity, suicides in relatives), impairment of neuromediator exchange (neurotransmitters serotonin, dopamine, adrenaline, and noradrenaline), neuromorphologic alterations in brain sensorimotor cortex (motor function, attention, perception, memory, and emotional-motivational response), hormonal disturbances (neuroendocrine and metabolic) and psychoneuroimmunological patterns of association with CD. Psychopharmacotherapy in CD is constructed with account for depressive symptoms (antidepressants of activating/sedative action in long-term maintenance regime), background and co-occurring diseases (adequate and pathogenetic and immunotherapy) with involvement in case of absence of contraindications of substitutive hormonotherapy (estrogen, progesterone). Beyond conventional schemes of the therapy the alternative therapy of CD (acupuncture, yoga, phytoestrogen collections, and food additives) is discussed. For heightening the efficiency and safety of the therapy of CD the training in detection of CD signs both for female patients and nurses, psychologists, social workers is proposed.

аффективные расстройстваклимактерическая депрессиятревогаменопаузаклимактерические (нейровегетативныеметаболическиепсихоэмоциональные) нарушенияпсихофармакотерапияпсихотерапияпсихопрофилактика

affective disordersclimacteric depressionanxietymenopauseclimacteric (neurovegetativemetabolicpsychoemotional) disturbancespsychopharmacotherapypsychotherapypsychoprevention

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The authors declare that there are no conflicts of interest present.