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2012, Número 3

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Salud Mental 2012; 35 (3)


Perimenopausia y trastornos afectivos: aspectos básicos y clínicos

Flores RM, Martínez ML

Idioma: Español
Referencias bibliográficas: 84
Paginas: 231-240
Archivo PDF: 325.86 Kb.


RESUMEN

La depresión es un trastorno afectivo de origen multifactorial que se presenta con mayor frecuencia en la mujer que en el hombre. Las causas de esta diferencia se atribuyen tanto a factores sociales como biológicos. La coincidencia entre los periodos de fluctuaciones hormonales y la presencia de síntomas afectivos ha dado fuerza a la teoría de que los factores hormonales pueden ser una causa de la mayor prevalencia de depresión en la mujer. Los estudios básicos en los cuales no se presentan factores sociales sugieren que la depresión en la mujer podría tener un origen biológico.
Uno de los periodos de mayor riesgo en la mujer es la perimenopausia. De acuerdo con el Grupo de Trabajo de los Estadios de la Edad Reproductiva (STRAW), la perimenopausia comprende el periodo denominado transición a la menopausia más un año después de la última menstruación. Este periodo se caracteriza por ciclos menstruales de duración variable y fluctuaciones en la concentración de estrógenos y progesterona. Conforme los ciclos se hacen impredecibles, ocurre una disminución de estrógenos, que genera alteraciones fisiológicas y afectivas. Diversos estudios epidemiológicos han logrado relacionar la perimenopausia con cambios en el estado afectivo de la mujer.
Tomando en cuenta la hipótesis de que la privación de estrógenos se relaciona con los síntomas depresivos en la mujer, los tratamientos con estrógenos han sido considerados como una de las opciones terapéuticas. Los hallazgos clínicos son controvertidos, y la posible explicación son las diferencias en la metodología empleada en cada estudio, así como la falta de consistencia en la definición de perimenopausia y en los instrumentos de medición hormonal y del estado emocional de la mujer. De manera interesante, los estudios básicos apoyan la idea de que los estrógenos producen efectos antidepresivos importantes. Sin embargo, existen diferencias en la respuesta antidepresiva que dependen tanto del tipo de estrógeno como del estado hormonal de la hembra. Hasta el momento, los hallazgos más consistentes refieren al 17β-estradiol como la hormona más relevante para producir acciones antidepresivas en la hembra. El mismo estrógeno es efectivo en ratas viejas, con un periodo de privación hormonal moderado; sin embargo, deja de ser efectivo en la depresión experimental cuando ese periodo se extiende por varios meses.
Otra alternativa terapéutica para tratar la depresión en la perimenopausia y posmenopausia es la terapia combinada de agentes hormonales y fármacos antidepresivos. En dos estudios con un reducido número de pacientes se determinó que la adición de estrógenos favorece el efecto de los fármacos antidepresivos en mujeres con depresión refractaria a dichos tratamientos. La investigación básica aporta resultados consistentes al respecto, ya que, por un lado, se ha determinado que diferentes estrógenos inducen un efecto tipo antidepresivo en ratas ovariectomizadas, y por otro, que la administración de dosis subefectivas de dichos estrógenos facilita el efecto antidepresivo, o incluso acorta la latencia de aparición del efecto antidepresivo de fármacos como la fluoxetina, la desipramina y la venlafaxina. Los resultados sugieren que los estrógenos pueden interactuar con diferentes sistemas de neurotransmisión para mejorar las acciones de los fármacos antidepresivos. Más aún, ha sido demostrado que el sistema serotonérgico participa en buena medida en las acciones antidepresivas de algunos estrógenos, lo cual aporta más evidencia sobre las fallas en la neurotransmisión serotonérgica en etapas de privación hormonal.
La evidencia de los estudios básicos y clínicos apoya la idea de que la mujer tiene periodos de vulnerabilidad afectiva que se relacionan con cambios endocrinos importantes. Los tratamientos para la depresión en la mujer deben ser elegidos con base en las condiciones endocrinas de la paciente, así como en las características propias de los tratamientos.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Wise PM. Neuroendocrine correlates of aging. En: Conn PM, Freeman ME (eds.). Neuroendocrinology in physiology and medicine. Totowa, NJ: Human Press Inc.; 2000; pp. 371-387.

  2. Wu JM, Zelinski MB, Ingram DK, Ottinger MA. Ovarian aging and menopause: current theories, hypotheses and researches models. Exp Biol Med 2005;230:818-828.

  3. Lemini C, Canchola E. Effects of 17β-aminoestrogens on the sexual behavior of female rats. Physiol Behav 2009;96(4-5):662-666.

  4. Bernardi M, Vergoni AV, Sandrini M, Taglianini S et al. Influence of ovariectomy, estradiol and progesterone on the behavior of mice in an experimental model of depression. Physiol Behav 1989;45:1067-1068.

  5. Shors TJ, Leuner B. Estrogen-mediated effects on depression and memory formation in females. J Affect Disord 2003;71(1):85-96.

  6. Bekku N, Yoshimura H, Araki H. Factors producing a menopausal depressive-like state in mice following ovariectomy. Psychopharmacology 2006;187(2):170-180.

  7. Bekku N, Yoshimura H. Animal model of menopausal depressive-like state in female mice: prolongation of immobility time in the forced swimming test following ovariectomy. Psychopharmacology 2005;183(3):300-307.

  8. Picazo O, Estrada-Camarena E, Hernández-Aragón A. Influence of the post-ovariectomy time frame on the experimental anxiety and the behavioral actions of some anxiolytic agents. Eur J Pharmacol 2006;530(1- 2):88-94.

  9. Anisman H, Matheson K. Stress, depression and anhedonia: caveats concerning animal models. Neurosci Biobehav Rev 2005;29(4-5):525-546.

  10. Willner P. Chronic mild stress (CMS) revisited: consistency and behavioural- neurobiological concordance in the effects of CMS. Neuropsychobiology 2005;52:90-110.

  11. Porsolt R, Le Pichon M, Jalfre M. Depression: a new animal model sensitive to antidepressant treatments. Nature 1977;266:730-732.

  12. Detke M, Rickels M, Lucki I. Active behaviors in the rat forced swimming test differentially produced by serotonergic and noradrenergic antidepressants. Psychopharmacology 1995;121:66-72.

  13. Frye C, Walf A. Changes in progesterone metabolites in the hippocampus can modulate open field and forced swim test behavior of proestrous rats. Horm Behav 2002;41:306-315.

  14. Contreras C, Martínez-Mota L, Saavedra M. Desipramine restricts estral cycle oscillations in swimming. Prog Neuropsychopharmacol Biol Psychiat 1998;22:1121-1128.

  15. Contreras CM, Molina M, Saavedra M, Martínez-Mota L. Lateral septal neuronal firing increases during proestrus-estrus in the rat. Physiol Behav 2000;68(3):279-284.

  16. Molina-Hernández M, Téllez-Alcántara NP. Antidepressant-like actions of pregnancy, and progesterone in Wistar rats forced to swim. Psychoneuroendocrinology 2001;26(5):479-491.

  17. Dalla C, Antoniuo K, Droussopoulou G, Xagoraris M et al. Chronic mild stress impact: are female more vulnerable? Neuroscience 2005;135:703-714.

  18. Walf AA, Paris JJ, Frye CA. Chronic estradiol replacement to aged female rats reduces anxiety-like and depression-like behavior and enhances cognitive performance. Psychoneuroendocrinology 2009;34(6):909-916.

  19. Walf AA, Madeleine ER, Frye CA. Antidepressant effects of ERβ-selective estrogen receptor modulators in the forced swimming test. Pharmacol Biochem Behav 2004;78:52.

  20. Rachmann IL, Unnerstall JR, Pfaff DW, Cohen RS. Estrogens alter behavior and forebrain cfos expression in ovariectomized rats subjected to de forced swim test. Proc Natl Acad Sci 1998;95:13941-13946.

  21. Estrada-Camarena E, Fernández-Guasti A, López-Rubalcava C. Interaction between estrogens and antidepressants in the forced swimming test in rats. Psychopharmacology 2004;173:139-145.

  22. Rodríguez-Landa JF, Contreras CM, Bernal-Morales B, Gutiérrez-García AG et al. Allopregnanolone reduces immobility in the forced swimming test and increases the firing rate of lateral septal neurons through actions on the GABAA receptor in the rat. J Psychopharmacol 2006;21(1):76-84.

  23. Fernández-Guasti A, Picazo O. Flumazenil blocks the anxiolytic action of allopregnanolone. Eur J Pharmacol 1995;281:113-115.

  24. Urani A, Roman FJ, Phan VL, Su TP et al. The antidepressant-like effect induced by sigma(1)-receptor agonists and neuroactive steroids in mice submitted to the forced swimming test. J Pharmacol Exp Ther 2001;298(3):1269-1279.

  25. Frye CA, Rodhes ME, Petralia SM, Walf AA et al. 3α-Hydroxy-5α-pregnan- 20-one in the midbrain ventral tegmental area mediates social, sexual, and affective behaviors. Neuroscience 2006;138(3):1007-1014.

  26. Barbaccia ML, Roscetti G, Trabucci M, Mostalino MC et al. Time-dependent changes in rat brain neurooactive steroid concentrations and GABA receptor function after acute stress. Neuroendocrinology 1996;63:166-172.

  27. Genazzani AR, Monteleone P, Gambacciani M: Hormonal influence on the central nervous system. Maturitas 2002;43(1):S11-S17.

  28. Ciriza I, Carrero P, Frye CA, García-Segura LM. Reduced metabolites mediate neuroprotective effects of progesterone in the adult rat hippocampus. The synthetic progestine medroxyprogesterone acetate (Provera) is not neuroprotective. J Neurobiol 2006;66(9):916-928.

  29. Estrada-Camarena E, Fernández-Guasti A, López-Rubalcava C. Facilitating antidepressant-like actions of estrogens are mediated by 5-HT1A and estrogen receptors in the rat forced swimming test. Psychoneuroendocrinology 2006;31(8):905-914.

  30. Estrada-Camarena E, Rivera NM, Berlanga C, Fernández-Guasti A. Reduction in the latency of action of antidepressants by 17β-estradiol in the forced swimming test. Psychopharmacology 2008;201(3):351-360.

  31. Yamaguchi-Shima N, Yuri K. Age-related changes in the expression of ER-beta mRNA in the female rat brain. Brain Res 2007;1155:34-41.

  32. Walf AA, Ciriza I, García Segura LM, Frye CA. Antisense oligodeoxynucleotides for estrogen receptor-beta and alpha attenuate estradiol’s modulation of affective and sexual behavior, respectively. Neuropsychopharmacology 2008;33(2):431-440.

  33. Walf AA, Madeleine ER, Frye CA. Antidepressant effects of ERβ-selective estrogen receptor modulators in the forced swimming test. Pharmacol Biochem Behav 2004;78:52.

  34. Walf AA, Frye C. Antianxiety and antidepressive behavior produced by physiological estradiol regimen may be modulated by hypothalamic- pituitary-adrenal axis activity. Neuropsychopharmacology 2005;30(7):1288-1301.

  35. Estrada-Camarena E, Fernández-Guasti A, López-Rubalcava C. Antidepressant- like effect of different estrogenic compounds in the forced swimming test. Neuropsychopharmacology 2003;28:830-838.

  36. Fernández-Guasti A, Martínez-Mota L, Estrada-Camarena E, Contreras CM et al. Chronic treatment with desipramine induces an estrous-cycle dependent anxiolytic-like action in the burying Behavior, but not in the elevated plus maze. Pharmacol Biochem Behav 1999;63(1):13-20.

  37. Martínez-Mota L, Estrada-Camarena E, López-Rubalcava C, Contreras CM. Interaction of desipramine with steroid hormones on experimental anxiety. Psychoneuroendocrinology 2000;25(2):109-120.

  38. Dhir A, Kulkarni SK. Antidepressant-like effect of 17beta-estradiol: involvement of dopaminergic, serotonergic, and (or) sigma-1 receptor system. Can J Physiol Pharmacol 2008;86(10):726-735.

  39. Rossi DV, Burke TF, McCasland M, Hensler JG. Serotonin-1A receptor function in the dorsal raphe nucleus following chronic administration of the selective serotonin reuptake inhibitor sertraline. J Neurochem 2008;105(4):1091-1099.

  40. Raap D, DonCarlos L, García F, Muma N et al. Estrogen desensitizes 5-HT1A receptors and reduces levels of Gz,Gi1 and Gi3 proteins in the hypothalamus. Neuropharmacology 2000;39:1823-1832.

  41. Romano-Torres M, Fernández-Guasti A. Estradiol valerate elicits antidepressant-like effect in middle-aged female rats under chronic mild stress. Behav Pharmacol 2010;21:104-111.

  42. Belló M, Puentes-Rosas E, Medina-Mora ME. Prevalencia y diagnóstico de depresión en población adulta en México. Salud Pública Mex 2005;47(1):4-11.

  43. Kessler RC. Epidemiology of women and depression. J Affect Disord 2003;74:5-13.

  44. Weissman MM, Bland RC, Canino GJ. Cross-national epidemiology of major depression and bipolar disorder. J Am Med Assoc 1996;276:293-299.

  45. Halbreich U. Women´s reproductive related disorders (RRDs). J Affect Disord 2010;122(1-2):10-13.

  46. Backstrom T, Andersson A, Andre L. Pathogenesis in menstrual cyclelinked CNS disorders. Ann N Y Acad Sci 2003;1007:42-53.

  47. Bancroft J, Cook A, Davidson D. Blunting of neuroendocrine responses to infusion of L-tryptophan in women with premenstrual mood change. Psychol Med 1991;21:305-312.

  48. Henshaw C. Mood disturbance in the early puerperium: a review. Arch W Ment Health 2003;6:S33-S42.

  49. Josefsson A, Berg G, Nordin C. Prevalence of depressive symptoms in late pregnancy and postpartum. Acta Obstet Gynecol Scand 2001;80:251-255.

  50. Pearlstein T, Howard M, Salisbury A. Postpartum depression. Am J Obstet Gynecol 2009;200(4):357-364.

  51. Soules MR, Sherman SH, Parrot E. Executive summary: Stages of Reproductive Aging Workshop (STRAW). Fertil Steril 2001;76(5):874-878.

  52. Santoro N, Brown J, Adel T. Characterization of reproductive hormonal dynamics in the perimenopause. J Clin Endocrinol Metab 1996;81:1495-1501.

  53. Morrison JH, Brinton RD, Schmidt PJ. Estrogen, menopause and the aging brain: how basic neuroscience can inform hormone therapy in women. J Neurosci 2006;26:10332-10348.

  54. Rasgon N, Shelton S, Halbreich U. Perimenopausal mental disorders: Epidemiology and Phenomenology. CNS Spectrums 2005;10(6):471-478.

  55. Burger HG, Dudley EC, Robertson DM. Hormonal changes in the menopause transition. Recent Prog Horm Res 2002;57:257-275.

  56. Yamada M, Soda M, Fujiwara S. Follicle-stimulating hormone and oestradiol levels during perimenopause in a cohort of Japanese women. Int J Clin Pract 2008;62(10):1623-1627.

  57. Bromberger JT, Meyer PM, Kravitz HM. Psychologic distress and natural menopause: a multiethnic community study. Am J Public Health 2001;91:1435-1442.

  58. Yen JY, Yang MS, Wang MH. The associations between menopausal syndrome and depression during pre-, peri-, and post-menopausal period among Taiwanese female aborigines. Psychiat Clin Neurosci 2009;junio(abstract);30.

  59. Slaven L, Lee C. Mood and symptom reporting among middle-aged women: the relationship between menopausal status, hormone replacement therapy, and exercise participation. Health Psychol 1997;16:203-208.

  60. Juang KD, Wang SJ, Lu SR. Hot flashes are associated with psychological symptoms of anxiety and depression in peri- and post- but no premenopausal women. Maturitas 2005,52:119-126.

  61. Woods NF, Mariella A, Mitchell ES. Depressed mood symptoms during the menopausal transition: observations from the Seattle Midlife Women´s Health Study. Climacteric 2006;9:195-203.

  62. Schmidt PJ, Haq N, Rubinow DR. A longitudinal evaluation of the relationship between reproductive status and mood in perimenopausal women. Am J Psychiatry 2004;161(12):2238-2244.

  63. 63.Freeman EW, Sammel MD, Liu L. Hormones and menopausal status as predictors of depression in women transition to menopause. Arch Gen Psychiat 2004;61:62-70.

  64. Marteens LWF, Knottnerus JA, Pep VJ. Menopausal transition and increased depressive symptomatology: a community based prospective study. Maturitas 2002;42:195-2002.

  65. Cohen LS, Soares CN, Vitonis A. Risk for new onset of depression during the menopausal transition. Arch Gen Psychiat 2006;63:385-390.

  66. Woods NF, Smith-DiJulio K, Percival DB. Depressed mood during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women´s Health Study. Menopause 2008;15(2):223-232.

  67. Soares CN. The menopausal transition and depression : a window of vulnerability? Menopause Management 2008;marzo/abril:12-25.

  68. Soares CD, Almeida OP, Joffe H. Efficacy of estradiol for the treatment of depressive disorders in perimenopausal women: a double blind, randomized, placebo-controlled trial. Arch Gen Psychiat 2001;58:529-534.

  69. Stahl SM. Augmentation of antidepressant by estrogen. Psychopharmacol Bull 1998;34(3):319-321.

  70. Feld J, Halbreich U, Karkun S. The association of perimenopausal mood disorders with other reproductive- related disorders. CNS Spectrums 2005;10(6):461-470.

  71. Young EA, Rees Midgley A, Carlson NE. Alteration in the hypothalamic-pituitary-ovarian axis in depressed women. Arch Gen Psychiat 2000;57:1157-1162.

  72. Schmidt PJ, Murphy JH, Danaceau MA. Basal plasma hormone levels in depressed perimenopausal women. Psychoneuroendocrinology 2002;27(8):907-920.

  73. 73 Freeman EW, Sammel MD, Lin H. Associations of hormones and menopausal status with depressed mood in women with no history of depression. Arch Gen Psychiat 2006;63:375-382.

  74. Daly R, Danaceau M, Rubinow D. Concordant restoration of ovarian function and mood in perimenopausal depression. Am J Psychiat 2003;160: 1842-1846.

  75. Rajewska J, Rybakowsky J. Depression in premenopausal women: gonadal hormones and serotonergic system assessed by D-fenfluramine challenge test. Prog Neuro-Psychopharmacol Biol Psychiat 2003;27:705-709.

  76. Ryan J, Burger HG, Szoeke C. A prospective study of the association between endogenous hormones and depressive symptoms in postmenopausal women. Menopause 2009;16(3):509-517.

  77. Rohr UD. The impact of testosterone imbalance on depression and women´s health. Maturitas 2002;41(1):S25-S46.

  78. Stoppe G, Dören M. Critical appraisal of effects of estrogen replacement therapy on symptoms of depressed mood. Arch Womens Ment Health 2002;5:39-47.

  79. Schmidt PJ, Roca C, Rubinow DR. Clinical evaluation in studies of perimenopausal women: Position paper. Psychoparmacol Bull 1998;34(3):309-311.

  80. Soares CD, Almeida OP, Joffe H. Efficacy of estradiol for the treatment of depressive disorders in perimenopausal women: a double blind, randomized, placebo-controlled trial. Arch Gen Psychiat 2001;58:529-534.

  81. Schmidt PJ, Nieman L, Danaceau MA. Estrogen replacement in perimenopause- related depression: a preliminary report. Am J Obstet Gynecol 2000;183:414-420.

  82. Rasgon N, Altshuler LL, Fairbanks LA. Estrogen replacement therapy in the treatment of major depressive disorder in perimenopausal women. J Clin Psychiat 2002;63(Supl. 7):45-48.

  83. Morgan ML, Cook IA, Rapkin AJ. Estrogen augmentation of antidepressant in perimenopausal depression: a pilot study. J Clin Psychiat 2005;66(6):774-780.

  84. Dias RS, Kerr-Correa F, Moreno RA. Efficacy of hormone therapy with and without methyltestosterone augmentation of venlafaxine in the treatment of postmenopausal depression: a double-blind controlled pilot study. Menopause 2005;13(2):168-170.




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