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Yıl:2008; Cilt: 18; Sayı: 1>> Özet
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Klinik Psikofarmakoloji Bülteni; 2008;18(1):9-21
Depresyon tanısı almış kadınlarda nörosteroidler ve bilişsel işlevler
Ş Kartalcı, E Eşel, S Özsoy, M Kula, T Turan
Erciyes Üniversitesi T›p Fakültesi Psikiyatri AD, Kayseri
Amaç: Dehdroepiandrosteron (DHEA) ve onun sülfat esteri olan DHEAS GABA antagonistik özellikleri olan nörosteroidlerdir. Bu çalışmada amacımız depresif hastalarda DHEAS’nin serum düzeylerini ve onun salınışını kontrol eden sistemi deksametazon supresyon testi vasıtası yla araştırmak suretiyle, onun depresyonun patofizyolojisinde rol oynayı p oynamadığını ve varsa bu hormondaki değişikliklerle depresyonda oluşan bilişsel değişiklikler arasındaki ilişkiyi incelemekti. Antidepresan tedavinin bu değişkenleri etkileyip etkilemediği de bu çalışmanı n bir başka araştırma konusu idi. Yöntem: Depresif epizod içinde bulunan 43 kadın hasta ve 22 kadın kontrol deneği çalışmaya alındı. Bilişsel işlevleri incelemek üzere hastalarda antidepresan tedavi öncesi ve sonrasında, kontrollerde ise bir kez Rey İşitsel-Sözel Öğrenme Testi, Wechsler Erişkin Zekâ Ölçeğinin sayı menzilleri alt testleri ve Stroop testi uygulandı. Kontrollerde bir kez, hastalarda ise tedavi öncesi ve sonrasında iki kez olmak üzere bazal kortizol ve DHEAS düzeyleri ile her iki hormonun deksametazona verdiği cevaplar ölçüldü. Bulgular: Depresif kadınlar deksametazon supresyon testinde kontrollere göre deksametazona daha yüksek oranda kör cevap verdiler, bu bozukluk antidepresan tedaviden sonra düzeldi. Depresif kadınlarda bazal DHEAS düzeyi sağlıklı kadınlarınkinden yüksekti ve bu da antidepresan tedaviden sonra normale dönüyordu. Depresif kadınlar kontrollere kıyasla hafıza, öğrenme ve dikkat testlerinde yetersizlik gösterdiler ve bu bilişsel bozukluklar da tedavi ile düzelmekte idi. Sonuçlar: DHEAS’nin depresif epizod sırasında yükselmesi ve antidepresan tedaviden sonra düşmesi bulgusu DHEAS’nin depresyon ile nedensel bir ilişkisinin olabileceğini telkin etmektedir. Bu hormonun depresyonda yükselen kortizolün depresif duygu durumu ve bilişsel bozukluklar gibi zararlı etkilerini telafi etmek amacıyla yükselmiş olabileceğ i düşünülebilir.
Neurosteroids and cognitive functions in depressed women
Objective: Dehydroepiandrosterone (DHEA) and its sulfate ester
dehydroepiandrosterone sulfate (DHEAS) are known to be
neuroactive steroids and are proposed to have GABA antagonistic
properties. The aim of this study was to investigate whether DHEAS is
related to the pathophysiology of depression by examining
alterations in serum DHEAS levels and its regulatory factors by the
dexamethasone suppression test (DST), and whether there is any
relationship between these alterations and cognitive functions in
depression. We also investigated if any alteration takes place in these
hormonal variables with antidepressant treatment.
Methods: Forty-three female inpatients suffering from a depressive
episode and 22 healthy female controls were recruited. Rey Auditory-
Verbal Learning Test (RAVLT), Wechsler Adult Intelligence Scale-
Revised (WAIS-R), Digit Span Subtest (DSS) and Stroop Test were
carried out to evaluate cognitive functions in the patient group before
and after antidepressant treatment, and in the control subjects. In the
patient and control groups, morning blood cortisol and DHEAS levels
were measured followed by a DST. The same procedures were
repeated after the response to treatment in the patients who
responded to antidepressant treatment.
Results: Depressive women had a more blunted cortisol responses in
DST compared with the healthy women, and it was normalized with
antidepressant treatment. Serum baseline DHEAS level was higher in
the depressive women than that in the healthy women, and this was
also normalized by antidepressant treatment. Depressive women
had failure especially in memory, learning and attention tests
compared to the controls, and these impairments in cognitive abilities
recovered with antidepressant treatment.
Conclusions: These results suggest that DHEAS may have a causal
relationship with depression since elevated DHEAS levels before
treatment decreased to normal levels after a clinical response to
treatment. DHEAS may be elevated in order to mitigate the
depression-associated overactivity of cortisol and its harmful effects
such as depressive mood and cognitive impairments in depression.

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