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P.1.018 Serum dehydroepiandrosterone sulfate and cortisol levels in patients with different types of depression
Poster Sessions
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Serum dehydroepiandrosterone sulfate and cortisol levels in patients with different types of depression
Y.A. Kochetkov, K.V. Beltikova, L.N. Gorobets. Moscow Research Institute of Psychiatry, Poteshnaya, 3, Moscow, Russia Objectives: Dehydroepiandrosterone sulfate (DHEAS) is a circulating steroid with different important neurophysiological functions. It is supposed that DHEAS is a more sensitive parameter for the evaluation of the severity of depression than cortisol. The aim of the study was to investigate cortisol and DHEAS levels in different types of depression. Methods: There were examined 11 patients with depressive episode (F 32.1; DE) and 21 patients with recurrent depressive disorder (F 33.1; RDD). Serum cortisol and DHEAS levels were measured using immuneenzyme method before antidepressant treatment. Results: In patients with depressive episode DHEAS level (1.97-1-0.25 mg/ml) was significantly higher (P <0.05) as compared with that (1.29+0.20mg/ml) in patients with RDD. Cortisol level (610+ 130 nmol/ml) in all investigated patients was almost twice higher (P < 0.05) as compared with normal level (318±85 nmol/ml). There were no differences in cortisol level between patients with DE and RDD. Cortisol/DHEAS ratio in patients with DE (309-1-69) was significantly lower (P <0.05) than in patients with RDD (421±97). Conclusions: We suppose that DHEAS level as well as cortisol/DHEAS ratio can serve as valuable indices for the purposes of differential diagnosis of different forms of depression.
References [1] Wolkowitz O.M., Epel E.S., Reus V.I. (2001) Stress hormone-related psychopathology: pathophysiological and treatment implications. World J Biol Psychiat 2: 115-143. [2] Deuschle M, Luppa P, Gilles M, Hamann B, Heuser I (2004) Antidepressant treatment and dehydroepiandrosterone sulfate: different effects of amitriptyline and paroxetine. Neuropsychobiology 50(3): 252-6.
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Typology of seasonal depressions
V.E. Medvedev. Mental Health Research Centre of the
Russian Academy of Medical Science, Moscow, Russia Objective: The purpose of this study was typology of depressions, which satisfy criteria of seasonal affective
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disorder (SAD), to analyze their structure, clinical course and therapy strategies. Method: The clinical and follow-up observation of 97 patients (28 male, 71 female; mean age 31.8 years). Results: Two types of SAD showing significant clinical differences are revealed. Affective phases in the I type SAD (n=59) are found to be of mild and moderate severity (HAMD - 14-16). The main affective symptoms are apathy and anhedonia. Somatoform phenomena and hyperesthetic disorders of vital inclinations such as hypersomnia and hyperphagia predominate. Affective phases in II type SAD (n = 38) manifest as severe melancholic depressions (HAMD >30). Anxiety and melancholy accompanied by depersonalization dominate. Somatoform symptoms include anesthetic disorders (78%) or detachment of vital senses (22%) such as loss of sleep and gustatory senses, decrease of food need. These types differ in disease course significantly. The I type SAD is characterized by the earlier onset (manifestation in 15-25 years; average time of disease duration - 12 years). A bipolar type is common (64%): autunm-winter depression alternates with hypomania in spring and summer. The duration of depressive phases is not longer than 4 months. The affective phases repeat yearly in a form of "clich6" without any differences in severity and quality of remissions. The later onset of the II type SAD is more common (manifestation in 40-60 years; average time of disease duration - 21 years). The course of the disease is less favorable. Annual depressions last from the early autumn up to the end of the spring achieving the duration of 9 months. The disease course is monopolar (89%). It is characterized by increasing severity of the depressive disorder, rising duration and deterioration of remission quality. In 44% of cases subdepressive condition, anxiety and hypochondriasis are observed even in summer time (so-called "double depression"). Response to the psychopharmacological treatment is found to depend on the SAD type. Therapy with SSRI or another selective antidepressant drug (tianeptine, mirtazapine, etc.) alone in an average therapeutic dose is enough for reduction of depression in the I type SAD. In the case of II type SAD it is necessary to use a long-term combined therapy with tricyclic antidepressants, tranquilizers and antipsychotic drugs, both traditional (haloperidol, trifluoperasine) and atypical (risperidone, olanzapine). In 37% of cases we have used electroconvulsive therapy to overcome drug resistant depressions. The results o four research show that disorders attributed to "SAD" can be at least subdivided into two types which differ in clinical manifestation, course and therapy response.
•
Serum dehydroepiandrosterone sulfate and cortisol levels in patients with different types of depression
Y.A. Kochetkov, K.V. Beltikova, L.N. Gorobets. Moscow Research Institute of Psychiatry, Poteshnaya, 3, Moscow, Russia Objectives: Dehydroepiandrosterone sulfate (DHEAS) is a circulating steroid with different important neurophysiological functions. It is supposed that DHEAS is a more sensitive parameter for the evaluation of the severity of depression than cortisol. The aim of the study was to investigate cortisol and DHEAS levels in different types of depression. Methods: There were examined 11 patients with depressive episode (F 32.1; DE) and 21 patients with recurrent depressive disorder (F 33.1; RDD). Serum cortisol and DHEAS levels were measured using immuneenzyme method before antidepressant treatment. Results: In patients with depressive episode DHEAS level (1.97-1-0.25 mg/ml) was significantly higher (P <0.05) as compared with that (1.29+0.20mg/ml) in patients with RDD. Cortisol level (610+ 130 nmol/ml) in all investigated patients was almost twice higher (P < 0.05) as compared with normal level (318±85 nmol/ml). There were no differences in cortisol level between patients with DE and RDD. Cortisol/DHEAS ratio in patients with DE (309-1-69) was significantly lower (P <0.05) than in patients with RDD (421±97). Conclusions: We suppose that DHEAS level as well as cortisol/DHEAS ratio can serve as valuable indices for the purposes of differential diagnosis of different forms of depression.
References [1] Wolkowitz O.M., Epel E.S., Reus V.I. (2001) Stress hormone-related psychopathology: pathophysiological and treatment implications. World J Biol Psychiat 2: 115-143. [2] Deuschle M, Luppa P, Gilles M, Hamann B, Heuser I (2004) Antidepressant treatment and dehydroepiandrosterone sulfate: different effects of amitriptyline and paroxetine. Neuropsychobiology 50(3): 252-6.
~
Typology of seasonal depressions
V.E. Medvedev. Mental Health Research Centre of the
Russian Academy of Medical Science, Moscow, Russia Objective: The purpose of this study was typology of depressions, which satisfy criteria of seasonal affective
Sl13
disorder (SAD), to analyze their structure, clinical course and therapy strategies. Method: The clinical and follow-up observation of 97 patients (28 male, 71 female; mean age 31.8 years). Results: Two types of SAD showing significant clinical differences are revealed. Affective phases in the I type SAD (n=59) are found to be of mild and moderate severity (HAMD - 14-16). The main affective symptoms are apathy and anhedonia. Somatoform phenomena and hyperesthetic disorders of vital inclinations such as hypersomnia and hyperphagia predominate. Affective phases in II type SAD (n = 38) manifest as severe melancholic depressions (HAMD >30). Anxiety and melancholy accompanied by depersonalization dominate. Somatoform symptoms include anesthetic disorders (78%) or detachment of vital senses (22%) such as loss of sleep and gustatory senses, decrease of food need. These types differ in disease course significantly. The I type SAD is characterized by the earlier onset (manifestation in 15-25 years; average time of disease duration - 12 years). A bipolar type is common (64%): autunm-winter depression alternates with hypomania in spring and summer. The duration of depressive phases is not longer than 4 months. The affective phases repeat yearly in a form of "clich6" without any differences in severity and quality of remissions. The later onset of the II type SAD is more common (manifestation in 40-60 years; average time of disease duration - 21 years). The course of the disease is less favorable. Annual depressions last from the early autumn up to the end of the spring achieving the duration of 9 months. The disease course is monopolar (89%). It is characterized by increasing severity of the depressive disorder, rising duration and deterioration of remission quality. In 44% of cases subdepressive condition, anxiety and hypochondriasis are observed even in summer time (so-called "double depression"). Response to the psychopharmacological treatment is found to depend on the SAD type. Therapy with SSRI or another selective antidepressant drug (tianeptine, mirtazapine, etc.) alone in an average therapeutic dose is enough for reduction of depression in the I type SAD. In the case of II type SAD it is necessary to use a long-term combined therapy with tricyclic antidepressants, tranquilizers and antipsychotic drugs, both traditional (haloperidol, trifluoperasine) and atypical (risperidone, olanzapine). In 37% of cases we have used electroconvulsive therapy to overcome drug resistant depressions. The results o four research show that disorders attributed to "SAD" can be at least subdivided into two types which differ in clinical manifestation, course and therapy response.