Juruena Mario Francisco, Cleare Anthony James
Seção de Neurobiologia dos Transtornos de Humor, Instituto de Psiquiatria, King's College, Universidade de Londres, UK.
Braz J Psychiatry. 2007 May;29 Suppl 1:S19-26. doi: 10.1590/s1516-44462007000500005.
We reviewed previous studies that have described an association between abnormal functioning of the hypothalamic-pituitary-adrenal axis and depression. In addition to melancholic depression, a spectrum of conditions may be associated with increased and prolonged activation of the hypothalamic-pituitary-adrenal axis. In contrast another group of states is characterized by hypoactivation of the stress system, rather than sustained activation, in which chronically reduced secretion of corticotropin releasing factor may result in pathological hypoarousal and an enhanced hypothalamic-pituitary-adrenal negative feedback. Patients with atypical depression, seasonal affective disorder and chronic fatigue syndrome fall in this category.
The literature data on the overlap between the key-words were reviewed, summarized and discussed.
Many studies suggest that these conditions themselves overlap biologically, showing hypofunction of central corticotropin releasing factor neuronal systems.
Therefore, in the real world of clinical practice, patients often present in a grey area between classical idiopathic fatigue and early chronic atypical depression and/or seasonal depression. This underscores the potential common biological links underpinning common symptom clusters not only between depression (atypical and seasonal) and chronic fatigue syndrome, but also other conditions characterized by the hypothalamic-pituitary-adrenal axis mainly diminished the corticotropin realising factor activity.
我们回顾了先前描述下丘脑 - 垂体 - 肾上腺轴功能异常与抑郁症之间关联的研究。除了 melancholic 抑郁症外，一系列病症可能与下丘脑 - 垂体 - 肾上腺轴的激活增加和延长有关。相比之下，另一组状态的特征是应激系统激活不足，而非持续激活，其中促肾上腺皮质激素释放因子的慢性分泌减少可能导致病理性低唤醒和下丘脑 - 垂体 - 肾上腺负反馈增强。非典型抑郁症、季节性情感障碍和慢性疲劳综合征患者属于这一类别。
对关键词重叠的文献数据进行回顾、总结和讨论。
许多研究表明，这些病症在生物学上存在重叠，表现为中枢促肾上腺皮质激素释放因子神经元系统功能减退。
因此，在临床实际中，患者常常处于经典特发性疲劳与早期慢性非典型抑郁症和/或季节性抑郁症之间的灰色地带。这强调了潜在的共同生物学联系，不仅支撑着抑郁症（非典型和季节性）与慢性疲劳综合征之间的共同症状群，还支撑着其他以下丘脑 - 垂体 - 肾上腺轴主要是促肾上腺皮质激素释放因子活性降低为特征的病症。
