Mello Andrea Feijo, Juruena Mario Francisco, Pariante Carmine M, Tyrka Audrey R, Price Lawrence H, Carpenter Linda L, Del Porto Jose Alberto
Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil, and Programa de Pesquisas em Transtornos do Humor, Hospital Butler, USA.
Braz J Psychiatry. 2007 May;29 Suppl 1(0 1):S13-8. doi: 10.1590/s1516-44462007000500004.
To review the new findings about stress, hypothalamic-pituitary-adrenal axis and depression trying to explain a possible endophenotype prone to depression.
Nonsystematic review of the literature based on the endophenotype hypothesis.
Depression is linked to hypercortisolemia in many patients, but not all patients present these hypothalamic-pituitary-adrenal axis dysfunction. The dexamethasone suppression test is not the most accurate test to measure the hypothalamic-pituitary-adrenal axis function, and its use in the first studies published probably jeopardized the results. Hypercortisolemia frequently occurs in patients with severe depression, melancholic, either psychotic or nonpsychotic type; it is linked to the presence of a polymorphism in the promoter of the serotonin transporter gene, with a history of childhood abuse or neglect, or other significant stressful experiences like the loss of a parent during childhood and temperament leading to alterations in the response to stress.
The alterations of the hypothalamic-pituitary-adrenal axis depend on many factors like severity and type of depression, genotype, history of exposure to stress, temperament, and probably resilience. All these factors together result in an endophenotype thought to be prone to depression.
回顾关于应激、下丘脑 - 垂体 - 肾上腺轴与抑郁症的新发现，试图解释一种可能易患抑郁症的内表型。
基于内表型假说对文献进行非系统性综述。
抑郁症在许多患者中与皮质醇增多症相关，但并非所有患者都存在下丘脑 - 垂体 - 肾上腺轴功能障碍。地塞米松抑制试验并非测量下丘脑 - 垂体 - 肾上腺轴功能的最准确试验，其在最初发表的研究中的使用可能影响了结果。皮质醇增多症常见于重度抑郁症、 melancholic（此处可能有误，推测为melancholic type，即抑郁发作伴有明显的抑郁情绪，可译为“抑郁发作伴明显抑郁情绪型”）、精神病性或非精神病性类型的患者中；它与血清素转运体基因启动子的多态性、童年期受虐待或被忽视的经历、或其他重大应激经历（如童年期父母一方的离世）以及导致应激反应改变的气质类型有关。
下丘脑 - 垂体 - 肾上腺轴的改变取决于许多因素，如抑郁症的严重程度和类型、基因型、应激暴露史、气质类型，可能还有心理弹性。所有这些因素共同导致一种被认为易患抑郁症的内表型。
