性激素与抑郁症的关系研究进展

抑郁症患者存在性腺功能的异常,本文对性激素与抑郁症发生机制中可能起的作用和影响及其变化作一综述。     

万拉法新对抑郁症患者血清性激素的影响

目的 探讨万拉法新对抑郁瘟患血清性激素的影响。方法 用放免法测定42例抑郁症患治疗前和治疗后1、6周末血清催乳素(PRL)、促滤泡成熟激素(FSH)、促黄体生成素(LH)、睾酮(T)、雌二醇(E2)，并与30例健康对照。结果 抑郁症组男性LH、E2和女性PRL、FSH与对照组比较明显升高。治疗后1、6周末男性患PRL、T、E2和女性PRL、T有显差异。结论 抑郁症患存在下丘脑—垂体—性腺轴内分泌异常，万拉法新可引起抑郁症患性激素分泌变异。     

性激素对青春期抑郁症的影响研究进展

青春期抑郁症的发病率呈逐渐升高的趋势,其对社会功能的影响程度远远超过成年期抑郁症。在青春期抑郁症中,发病率及临床表现均表现出了明显的性别差异。目前国内外的研究均提示性激素在促进性别分化的同时也将导致青春期抑郁症出现性别差异。因此,对性激素影响青春期抑郁症性别差异的发生机制研究在青春期抑郁症的临床诊断和治疗中具有重要意义。     

首次发作抑郁症患者血清性激素水平研究

目的:探讨性激素(睾酮、雌二醇、孕酮)对首次发作抑郁症患者的药物治疗疗效的影响。方法:对93例住院抑郁症患者给予5-羟色胺再摄取抑制剂(SSRIs)治疗4周,分别于治疗前后检测血清性激素。按治疗前后汉密尔顿抑郁量表(HAMD,17)减分率分为痊愈组(减分率≥75%)和未愈组(减分率<75%),分析两组性激素水平。结果:男性患者中,治疗后睾酮及雌二醇水平均比治疗前有显著提高,孕酮水平较治疗前有明显降低,痊愈组治疗后睾酮及雌二醇水平均高于未愈组,孕酮的差异无显著性,睾酮及雌二醇增加率与HAMD减分率存在显著正相关,而孕酮的减少率则与HAMD无显著相关。女性患者中,治疗前后及两组间睾酮水平的差异无显著性,治疗后雌二醇有显著性增高,但痊愈组与未愈组治疗前后差异无显著性,雌二醇的增加率与HAMD减分率之间未发现显著相关;同时治疗后孕酮显著降低,且治疗后两组间孕酮水平差异显著,孕酮的减少率与HAMD减分率之间存在显著正相关。结论:血清睾酮、雌二醇水平的升高对首次发病的男性抑郁症患者药物疗效有影响,而女性患者的治疗效果与孕酮降低程度有关。     

首发精神疾病患者性激素水平的横断面比较

目的 比较常见首发精神疾病基线期性激素水平的差异.方法 回顾性调查2012年1月至2017年12月在苏州市广济医院住院的514例首发精神疾病患者,其中精神分裂症患者226例,双相情感障碍患者90例,抑郁症患者198例,收集人口学资料及基线期各组患者的黄体生成素(LH2)、卵泡刺激素(FSH)、泌乳素(PRL)、雌二醇(...     

城乡抑郁症患者对照分析

对我院2000年至2001年期间门诊首次诊断为抑郁症的城乡患者各40例进行对照分析，报告如下。     

抑郁症患者血清胆固醇、脂蛋白和载脂蛋白的水平及其意义

目的 探讨抑郁症患者血清水平及其临床意义。方法 采用酶法及免疫比浊法检测６６例抑郁症和３６名健康对照者的血清胆固醇（ＴＣ）,甘油三脂（ＴＧ）,高密度脂蛋白－胆固醇（ＨＤＬ－Ｃ）低密度脂蛋白－胆固醇（ＬＤＬ－Ｃ）,载脂蛋白ＡＩ（ａｐｏＡＩ）和载脂蛋白Ｂ（ａｐｏＢ）水平,并比较其中内源性抑郁患者（３４例）与非内源性抑郁患者（３２例）,有自杀行为者（２５例）与无自杀行为者（４１例）的血脂水平。结果 与对     

某些精神疾病患者的性激素研究

目的：研究情感性精神障碍和精神分裂症患者外周性激素的功能状态。方法：选择躁狂症、抑郁症、精神分裂症阳性症和阴性发作期女性患者各20例，缓解期各10例。采用放射免疫法测定女性患者的血清睾丸酮（T）、雌二醇（E2)水平，并与20名女性健康者对照。结果：躁狂症和精神分裂症发作期T水平明显高于对照组，且躁狂症又明显高于精神分裂症。抑郁症发作期E2水平明显高于对照组。结论：精神症状和情绪是性激素的影响因素。     

精神分裂症患者性激素水平动态观察

对９０例精神分裂症男性病人做了性激素水平的动态变化测定，并与一组正常人（３３例男性）进行了比较，研究结果显示，病人组疗后睾酮（Ｔ）水平显著低于疗前，其变化与疗后简明精神病量表（ＢＰＲＳ），阴性症状量表（ＳＡＮＳ），阳性症状量表（ＳＡＰＳ）亦显著低于疗前，均有密切关系，病人组疗前和疗后Ｔ均显著低于正常对照组，而未婚者疗后促卵泡激素（ＦＳＨ）水平又显著低于已婚和离婚，丧偶者。     

精神分裂症患者的性激素分泌变异

为研究精神分裂症患者垂体促性腺激素及外周性激素的功能状态，探讨性激素水平改变与性有关症状和药物治疗的关系，采用放射免疫法测定６０例（男４０例，女２０例）精神分裂症患者的血清促卵泡激素（ＦＳＨ）、黄体生成素（ＬＨ）、催乳素（ＰＲＬ）、睾丸酮（Ｔ）、雌二醇（Ｅ２）等激素水平，并与２０名（男女各１０名）正常人对照。结果显示，试验组中男性ＬＨ和女性ＰＲＬ水平明显低于对照组，女性患者的Ｔ与Ｅ２水平显著升高。按性有关症状的有无分为两组，两组间性激素水平无显著性差异。药物治疗前后男患者ＰＲＬ，女患者ＦＳＨ、ＰＲＬ、Ｔ和Ｅ２等激素分泌改变非常显著。氯丙嗪、舒必利可致明显的高ＰＲＬ血症，但氯氮平无明显影响。提示精神分裂症患者性腺轴存在功能失调。性有关症状与性激素水平改变无关。抗精神病药治疗可导致性激素分泌紊乱。     

Associations between sex steroid hormone levels and depressive symptoms in elderly men and women: results from the Health ABC study

INTRODUCTION: Sex steroid hormone levels decline with age and in some studies this decline has been linked with depressive symptoms. This study investigates the association between total testosterone, free testosterone, and DHEAS levels with depressive symptoms in a well-functioning elderly population. METHODS: Data are from 2855 well-functioning elderly men and women, 70-79 years of age, participating in the Health, Aging, and Body Composition study. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression scale. Total testosterone, free testosterone, and DHEAS levels were assessed after an overnight fast. RESULTS: In men and women, DHEAS levels and depressive symptoms were inversely associated after adjustment for covariates (men: beta=-0.059, p=0.03, women: beta=-0.054, p=0.05). In addition, free testosterone levels in women, but not in men, were inversely associated with depressive symptoms (adjusted beta=-0.079, p=0.004). Men, but not women, in the lowest total testosterone quartile reported significantly more depressive symptoms than men in the other total testosterone quartiles (adjusted beta=-0.166, p=0.04). DISCUSSION: Our study is consistent with the idea that testosterone and DHEAS levels may play a role in mechanisms underlying depressive symptoms in old age.     

不同性别首次发作抑郁症的临床特征对比

目的：探讨不同性别首次发作抑郁症临床特征的异同。方法：采用一般情况问卷、抑郁白评量表(SDS)和汉密顿抑郁量表(HAMD)对不同性别首发抑郁症患者进行测查。结果：女性首发抑郁症患者发病年龄显著低于男性，HAMD的躯体化／焦虑、睡眠因子显著高于男性，而认识障碍、迟缓和绝望因子评分显著较男性为低。另外，女性抑郁症患者的共病显著高于男性。结论：不同性别首次发作抑郁症的临床特征存在一定的差异。     

Illness perceptions among cardiac patients: relation to depressive symptomatology and sex

OBJECTIVE: This study examined cardiovascular disease (CVD) illness perceptions and how they relate to depressive symptomatology among women and men. METHODS: Acute coronary syndrome (ACS) patients at two hospitals were approached, and 661 consented to participate (504 men, 157 women; 75% response rate). Participants completed a survey including the Hospital Anxiety and Depression Scale (HADS) and Illness Perception Questionnaire (IPQ). RESULTS: Women perceived a significantly more chronic course (P<.001) and more cyclical episodes (P<.05) than men did, while men perceived greater personal control (P<.001) and treatability (P<.05) than women did. Participants perceived diet, heredity, and stress as the greatest CVD causes. For women (F=5.49, P<.001), greater depressive symptomatology was significantly related to younger age (P<.05), lower activity status (P<.001), and perceiving a chronic time course (P<.01). For men (F=7.68, P<.001), greater depressive symptomatology was significantly related to being non-white (P<.05), lower activity status (P<.001), less exercise behavior (P=.01), and three illness perceptions, namely, perceiving a chronic course (P<.05), greater consequences (P<.001), and lower treatability (P<.05). CONCLUSION: Women, compared with men, are more likely to attribute CVD to causes beyond their control and to perceive CVD as a chronic, untreatable condition. Illness perceptions were related to depressive symptomatology, which suggests that interventions to reframe these perceptions may be warranted to improve emotional health in the context of CVD.     

Total testosterone, androgen receptor polymorphism, and depressive symptoms in young black and white men: the CARDIA Male Hormone Study

Androgen receptor (AR) CAG repeat length (RL) might modify the relationship between endogenous testosterone (T) and depressive symptoms in men on average over age 50 years. We hypothesized that CAG RL modifies the association between T and depressive symptoms in 525 black and 721 white men under age 40 years participating in the CARDIA Male Hormone Study. We assessed cross-sectional associations of quartiles of total and bioavailable T and tertiles of CAG RL with depressive symptoms, defined as Center for Epidemiologic Studies Depression Scale (CES-D) score > or=16, in 1995-1996. The interaction of CAG RL and total T on depressive symptoms was statistically significant for blacks, whites, and both groups combined. In the combined analysis, the odds ratios (OR) (95% confidence intervals (CI)) across the quartiles of total T were 1.00, 0.17 (95% CI=0.07-0.43), 0.31 (95% CI=0.14-0.70), and 0.49 (95% CI=0.22-1.09) for the shortest RL group. The interaction of CAG RL and bioavailable T on depressive symptoms was statistically significant for black men only, and nonsignificant in a combined analysis. For black men in the shortest RL group, the ORs for the quartiles of bioavailable T were 1.00, 0.41 (95% CI=0.16-1.05), 0.10 (95% CI=0.03-0.38), and 0.35 (95% CI=0.14-0.90). In other CAG groups, there were no relationships of total or bioavailable T with depressive symptoms. CAG RL might modify the association between endogenous total and bioavailable T and depressive symptoms in younger black men. Clinical trials assessing the effects of T replacement therapy on depressive symptoms in hypogonadal men should consider including CAG RL in their design and/or analysis.     

Epilepsy, Sex Hormones, and Antiepileptic Drugs

Summary: Many factors associated with hormone function have an impact on the course of epilepsy. Patients with epilepsy may have disturbances in sexual function such as anovulatory cycles in women and decreased libido and potency in men. Data indicate seizures, especially those arising in the limbic system, may influence the hypothalamic pituitary axis. Antiepileptic drugs also influence sexual function through direct brain effects as well as through induced changes in pharmacokinetics of the sex steroid hormones. Pregnancy has been reported to be a time of increased seizures; however, this has often been associated with low drug levels, for reasons that include inadequate drug dose, possible changes in pharmacokinetics, and noncompliance. Some evidence suggests that hormones affect seizure frequency. Changes in seizures during the menstrual cycle (catamenial epilepsy) have been found in some women: seizures were fewer during the luteal phase but increased when progesterone levels declined. Some improvement in seizure frequency has been shown in pilot studies using medroxyprogesterone acetate, a synthetic progesterone. Current concepts of the interrelationship among epilepsy, sex hormones, and antiepileptic drugs are discussed.     

Sex hormone levels in drug-naïve,first-episode patients with psychosis

Abstract

Aim: Sex differences have long been reported in schizophrenia leading to the hypothesis that sex hormones may be implicated in the pathophysiology of the disorder. We assessed gonadal hormones during the fasted state in drug-naïve patients with psychosis.

Method: Fasting serum concentrations of follicular-stimulating hormone (FSH) and luteinizing hormone (LH), testosterone, free-testosterone, Sex Hormone Binding Globulin (SHBG) and oestradiol (E₂) were compared between a group of 55 newly diagnosed, drug-naïve, first-episode men with psychosis and a group of 55 healthy controls, matched for age, smoking status and BMI. Testosterone, free-testosterone and SHBG were compared between a group of 32 drug-naïve, first-episode females with psychosis and a group of 32 healthy controls matched for age, smoking status and BMI.

Results: Testosterone and free-testosterone levels were significantly lower in the patients’ group and SHBG levels significantly higher in the patients’ group compared to those in healthy controls. The two female groups had similar values in the hormones which were measured.

Conclusion: Our findings provide evidence of lower testosterone and free-testosterone levels and increased SHBG levels in drug-naïve, first-episode males with psychosis.

• KEY POINTS

• Reduced testosterone and free-testosterone levels in drug-naive, first-episode males with psychosis.

• Increased SHBG levels in drug-naive first-episode males with psychosis.

• No difference in FSH, LH and E2 levels between drug-naive first episode males with psychosis and controls.

• No difference in testosterone, free-testosterone and SHBG levels between drug-naive, first-episode women with psychosis and controls.

     

Growth hormone release after desipramine in depressive illness

Summary The effect of i.m. administration of 75 mg of desipramine on growth hormone (GH) secretion was investigated in a sample of 87 patients with major depressive disorders and in 31 normal controls. The GH response was lower in depressed females compared to depressed males, but no such difference was present in controls. In the premenopausal female group, GH response was significantly lower in depressed patients than in controls. No significant difference was found between normal males and male depressed patients. In the premenopausal group, no difference emerged between endogenous and nonendogenous depressed women.     

Cross-sex hormone treatment does not change sex-sensitive cognitive performance in gender identity disorder patients

Cognitive performance in untreated early onset gender identity disorder (GID) patients might correspond to their born sex and not to their perceived gender. As a current mode of intervention, cross-sex hormone treatment causes considerable physical changes in GID patients. We asked, as has been suggested, whether this treatment skews cognitive performance towards that of the acquired sex. Somatically healthy male and female early onset GID patients were neuropsychologically tested before, 3 and 12 months after initiating cross-sex hormone treatment, whereas untreated healthy subjects without GID served as controls (C). Performance was assessed by testing six cognitive abilities (perception, arithmetic, rotation, visualization, logic, and verbalization), and controlled for age, education, born sex, endocrine differences and treatment by means of repeated measures analysis of variance. GID patients and controls showed an identical time-dependent improvement in cognitive performance. The slopes were essentially parallel for males and females. There was no significant three-way interaction of born sex by group by time for the six investigated cognitive abilities. Only education and age significantly influenced this improvement. Despite the substantial somatic cross-sex changes in GID patients, no differential effect on cognition over time was found between C and GID participants. The cognitive performance of cross-sex hormone-treated GID patients was virtually identical to that of the control group. The documented test–retest effect should be taken into consideration when evaluating treatment effects generally in psychiatry.