Coupland Nick J, Hegadoren Kathleen M, Myrholm Jessica
Department of Psychiatry, University of Alberta Hospital, Edmonton, AB.
J Psychiatry Neurosci. 2003 Sep;28(5):364-9.
It has been hypothesized that abnormal negative feedback of cortisol release in major depressive disorder (MDD) may involve impaired central glucocorticoid receptor (GR) function. Beclomethasone-induced vasoconstriction (BIV) was recently used to test the hypothesis that impaired GR function generalizes to peripheral tissues, and it was reported that BIV was decreased in medicated patients with MDD. The objective was to test the hypothesis that BIV would be reduced in unmedicated women with MDD compared with healthy controls.
Case-control.
A university womens' mental health research unit.
Women aged 18-65 years (n=19) diagnosed, according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, with MDD after a structured interview and clinical assessment. Healthy women pair-matched for age, reproductive and smoking status.
BIV was tested using a range of beclomethasone dipropionate concentrations (1-100 microg/mL) applied to the forearm, with vasoconstriction scored visually after 15-18 hours by raters blinded to diagnosis and the randomization of the application sites.
Visual scores for BIV at each beclomethasone concentration.
No significant differences between patients with MDD and controls were found. Postmenopausal women showed less of a response than premenopausal women or women taking sex-hormone preparations.
The study did not concur with the previous finding that BIV is decreased in MDD. Further research is needed to determine whether the difference in findings is due to medication or to other factors that may have distinguished the samples, including sex, age, reproductive status, illness severity, treatment resistance and setting.
据推测,重度抑郁症(MDD)中皮质醇释放的异常负反馈可能涉及中枢糖皮质激素受体(GR)功能受损。倍氯米松诱导的血管收缩(BIV)最近被用于检验GR功能受损会扩散至外周组织这一假说,并且有报道称,接受药物治疗的MDD患者的BIV降低。目的是检验与健康对照相比,未接受药物治疗的MDD女性的BIV会降低这一假说。
病例对照研究。
一所大学的女性心理健康研究单位。
年龄在18 - 65岁之间的女性(n = 19),根据《精神疾病诊断与统计手册》第四版,经结构化访谈和临床评估后被诊断为MDD。年龄、生殖和吸烟状况匹配的健康女性。
使用一系列不同浓度(1 - 100μg/mL)的二丙酸倍氯米松涂于前臂来检测BIV,在15 - 18小时后由对诊断和涂抹部位随机分组不知情的评估者通过肉眼观察血管收缩情况并评分。
每个倍氯米松浓度下BIV的肉眼观察评分。
未发现MDD患者与对照组之间存在显著差异。绝经后女性的反应比绝经前女性或服用性激素制剂的女性要小。
该研究结果与之前关于MDD患者BIV降低的发现不一致。需要进一步研究以确定研究结果的差异是由于药物治疗还是其他可能区分样本的因素,包括性别、年龄、生殖状况、疾病严重程度、治疗抵抗和研究环境。