from Part II - Biological basis
Published online by Cambridge University Press: 25 March 2010
Introduction
Recent advances in our understanding of hormone action in the brain, coupled with growing evidence of hormonal dysregulation in affective disorders, have prompted the use of hormones and hormone antagonists as endocrinologically based treatments of depression. Since hormonally based treatments presumably act at sites distinct from those of traditional antidepressants, they may specifically benefit patients unresponsive to the latter drugs. Clinical applications of psychoneuroendocrinology are largely in their infancy, but certain strategies have already entered clinical practice and others appear promising. The following selective review begins with the more well-established hormonal therapies for treatment-resistant depression and concludes with less well-studied, but nonetheless biologically informed ones.
Thyroid
Although interest in the role of thyroid hormones in the biology of mood disorders is longstanding, the prevalence of abnormalities and their pathophysiologic significance remains controversial (Fava et al., 1995; Howland, 1995). Some, but not all, investigators have found a higher rate of elevations in total T4 and FT4 in the depressed population than in controls (JoVe & Sokolov, 1994; Nader et al., 1995; Scherer, 1994). Alterations in T3 level and an increased prevalence of antithyroid antibodies have also been reported (Reus & Freimer, 1990), as have low levels of CSF transthyretin (Sullivan et al., 1999). Frank hypothyroidism is rarely found upon routine screening of patients with major depression, but subtle alterations in basal TSH and TSH response to TRH infusion are quite common (Bunevicius et al., 1994, 1996).
To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Find out more about the Kindle Personal Document Service.
To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.
To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.