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Órgano Oficial del Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz

2000, Number 4

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Salud Mental 2000; 23 (4)

Los esteroides gonadales y la afectividad: el papel de las hormonas sexuales en la etiología y el tratamiento de los trastornos afectivos

Berlanga C, Huerta R

Language: Spanish
References: 157
Page: 10-21
PDF size: 462.69 Kb.


ABSTRACT

Gender differences in the prevalence of mood disorders have been well documented, It has been estabilished in large epidemiological studies that major depression has a life-time prevalence of about 21.7% in female and 12.7% in males. In addition, both adolescents and adult females are more likely than age-matched males to develop posttraumatic stress disorder,Bering the same importance is the fact that some women have mood cycles that vary eystematically with the menstrual cycle, while others are more apt to develop symptoms in spesial periods, such as the postpartun and during the years of perimenopause.Although postmenopausal womwn do not seem to be at increased risk for major depression, the postmenopausal status confers a vulnerability to this illness. The reason of these differences have not been yet completely established, but several lines of evidence suggest that gonodal steriodes may play role in the generation of depressive illnesses in women.Its is important to stress that gonadal steriodes have different effects on the brain according to the organism´s developmental satge. Estrogen perinatally has effects on the brain structure not functionally evident until post-pudescence. These organizational effects contrast with the activational effects wich are short-term effects cauded by the changes in circulating hormose that occur after reaching puberly.Additionally, steroides hormones act on their specific receptor in the brain and affect the neuronal function and the neurotransmission.Thus labeling these hormones as reproductive only, is inaccurately.At the same time gonodal hormones have effects on the hypothalamic-pituitary-adrenal axis,and this might de one of several mechanisms by wich they influence the development and course af mood disorders.Sexual hormones can modulate cerebral functions at various levels.These include modifications of the neural structure, enforcing signaling transmission of neurotransmitters and neuropeptides and affecting the plasticity of synapses, among others.With respect to the utilization of these hormones as therapeutic agents,it is well known that the administration of exogenous estrogen or progesterone has complex effects on mood in women; both improvise and worsen moood.Perimeno pause may be associated with an increase in relatively mild mood syndromes, and evidence suggests that exogenous estrogen does have mild mood-elevating effects in this lifecycle period.Homever, there is not enough evidence to support the beneficial effects of administering estrogen in severe mood disorders.In this context, benefits should be weighed against risk,mainly in patients with a history of malignancy or thrombophlebitis.The role of gonadal steroides in treating depression requieres further investigation.In general, research in this area has increased markedly in recent years.This is important because considering gender related aspects provides a windows into both normal brain function and pathophysology.


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  111. KAUFERT PA, GILBERT P, TATE R: The Manitoba Proyect: a reexamination of the link between menopause and depression. Maturitas, 14:143-155, 1992.

  112. KENDELL RE, CHALMERS JC, PLATZ C: Epidemiology of puerperal psychoses. Br J Psychiatry, 150:662-673, 1987.

  113. KESSLER RC, MCGONAGLE KA, ZHAO S, NELSON CB, HUGHES M, ESHLEMAN S, WITTCHEN HU, KENDLER KS: Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Arch Gen Psychiatry, 51 :8-19, 1994.

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  116. KUIPER GC, CARLSON B, GRANDIER K: Comparison of the ligand binding specificity and transcript tissue distribution of estrogen receptors alpha and beta. Endocrinology, 138:863-870, 1997.

  117. LIEBENLUFT E: Issues in the treatment of women with bipolar illness. J Clin Psychiatry, 58 (supl):5-11, 1997.

  118. LUINE VN. KHYLCHEVSKAYA RJ. MCEWEN BS: Effect of gonadal steroids on activities of monoamine oxidase and choline acetylase in rat brain. Brain Res, 86:293-306, 1975.

  119. MAGILL PJ: Investigation of the efficacy of progesterone pessaries in the relief of symptoms of premenstrual syndrome. Br J Gen Pract, 45:589-593, 1995.

  120. MCEWEN BS, DAVIS PG, PARSONS B, PFAFF DW: The brain as a target for steroid hormone action. Am Rev Neurosci, 2:65-112, 1979.

  121. MERIKANGAS KR, WEISSMAN MM, PAULS DL: Genetic factors in the sex ratio of major depression. Psychol Med, 15:63-69, 1985.

  122. METZ A, STUMP K, COWEN PJ: Changes in platelet alpha2-adrenoreceptor binding post-partum: possible relation to maternity blues. Lancet, 1:495-498, 1983.

  123. MEYER ME, GRONEMEYER H, TURCOTTE B: Steroid hormone receptors compete for factors that mediate their enhancer functions. Cell, 57:433-442, 1989.

  124. NOPOULOS PC, ANDREASEN NC: Gender differences in neuroimaging findings. En: Liebenluft E (ed). Gender Differences in Mood and Anxiety Disorders. Review of psychiatric series, Oldham JO and Riba MB (series eds.), American Psychiatric Press, Pp. 1-24, Washington, 1999.

  125. O'HARA MW, SCHLECTE JA, LEWIS DA, VARNER MW: Controlled prospective study of postpartum mood disorders: psychological, environmental, and hormonal variables. J Abnorm Psychol, 100:63-73, 1991.

  126. OPPENHEIM G: A case of rapid mood cycling with estrogen: implications for therapy. J Clin Psychiatry, 45:34-35, 1984.

  127. PALERMO-NETO J, DORCE VAC: Influences of estrogen and/or progesterone on some dopamin related behavior in rats. Gen Pharmacol, 21:83-87, 1990.

  128. PARISER SF: Women and mood disorders: menarche to menopause. Ann Clin Psychiatry, 5:249-253, 1993.

  129. PARRY BL: Reproductive factors affecting the course of affective illness in women. Psychiatr Clin North Am, 12:207-220, 1989.

  130. PARRY BL: Reproductive related depressions in women: phenomena of hormonal kindling? En: Hamilton JA, Harberger PN (eds). Postpartum Psychiatric Illness: a Picture Puzzle. University of Pennsylvania Press, 200-218, Philadelphia, 1992.

  131. PAUL SM, AXELROD J, SAAVEDRA JM: Estrogeninduced efflux of endogenous catecholamines from the hypothalamus in vitro. Brain Res, 178: 499-505, 1979.

  132. REDMOND DE JR, MURPHY DL, BALTU J: Menstrual cycle and ovarian hormone effects on plasma and platelet monoamine oxidade (MAO) and plasma dopamine-betahydroxylase (DBH) activities in the rhesus monkey. Psychosom Med, 7:417-428, 1975.

  133. ROBEL P, BAULIER EE: Neurosteroids: biosynthesis and function. Crit Rev Neurobiol, 9:383-394,1995.

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