Wolkowitz Owen M, Burke Heather, Epel Elissa S, Reus Victor I
Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, California, USA.
Ann N Y Acad Sci. 2009 Oct;1179:19-40. doi: 10.1111/j.1749-6632.2009.04980.x.
Elevated circulating levels of glucocorticoids are associated with psychiatric symptoms across several different conditions. It remains unknown if this hormonal abnormality is a cause or an effect of the psychiatric conditions. For example, the hypercortisolemia observed in a subset of patients with depression may have a direct impact on the symptoms of depression, but it is also possible that the hypercortisolemia merely reflects the stress associated with depression. Further, rather than causing depression, hypercortisolemia could represent a homeostatic attempt to overcome glucocorticoid resistance. Each of these possibilities will be considered, and correlational and causal evidence will be reviewed. This article will focus on the relationships between glucocorticoids and psychiatric symptoms in Cushing's syndrome, major depression, and steroid psychosis/steroid dementia, as well as the effects of exogenously administered glucocorticoids in normal volunteers. Similarities and differences in the relationship of glucocorticoid hormones to psychiatric symptoms in these conditions will be reviewed. Possible mediators of glucocorticoid effects on the brain and behavior, as well as possible "pro-aging" effects of glucocorticoids in certain cells of the body, will be reviewed. The article concludes with a conceptual model of glucocorticoid actions in the brain that may lead to novel therapeutic opportunities.
在多种不同病症中，循环糖皮质激素水平升高与精神症状相关。目前尚不清楚这种激素异常是精神疾病的原因还是结果。例如，在一部分抑郁症患者中观察到的高皮质醇血症可能对抑郁症状有直接影响，但高皮质醇血症也可能仅仅反映了与抑郁症相关的压力。此外，高皮质醇血症并非导致抑郁症，而是可能代表一种克服糖皮质激素抵抗的稳态尝试。将考虑这些可能性中的每一种，并审查相关和因果证据。本文将重点关注库欣综合征、重度抑郁症和类固醇精神病/类固醇痴呆中糖皮质激素与精神症状之间的关系，以及外源性给予糖皮质激素对正常志愿者的影响。将审查这些病症中糖皮质激素与精神症状关系的异同。将审查糖皮质激素对大脑和行为影响的可能介质，以及糖皮质激素在身体某些细胞中可能的“促衰老”作用。文章最后提出了一个糖皮质激素在大脑中作用的概念模型，这可能带来新的治疗机会。
