양극성 장애 환자에서 월경 주기에 따른 증상과 Lithium농도의 변화

Abstract

Objectives：It was reported that symptoms change according to menstrual cycles, aggravation of symptoms 3 to 7 days before menstruation in bipolar disorder for example. Therefore, this study was to investigate the correlation among the change of symptoms, serum lithium level, estradiol and progesterone levels. Methods：For women with bipolar disorder, we divided by menstrual cycle into three groups；middle follicular phase, middle luteal phase and late luteal phase. We estimated serum lithiumlevel, estradiol and progesterone of each phase, and assessed the change of symptoms using Hamilton Rating Scale for Depression and Manic-State Rating Scale. Consequently they were divided into symptom changed group and not changed group. Results：Serum lithium levels of patients with bipolar disorder were significantly decreased in middle luteal phase compared with in middle follicular phase, and it was sustained in low level to late follicular phase. Although there were no statistically significant differences, there was more decreased serum lithium level in symptom changed group than in symptom unchanged group. Serum lithium levels were not statistically correlated with both estradiol and progesterone levels. When symptom changed group was compared with symptom not changed group, there was a significant correlation between changes of symptom and estradiol level. Conclusion：The possible mechanism of the change of symptoms according to menstrual cycle in bipolar disorder may be in estrogen level and due to the effect of serum lithium level change according to menstrual cycle. The investigation of this mechanism will contribute to the treatment and the prevention of recurrence symptons in bipolar disorder. (J Korean Neuropsychiatr Assoc 2004;43(4):393-400)