Covance, Princeton, NJ, USA.
Pharmacopsychiatry. 2012 May;45(3):83-95. doi: 10.1055/s-0031-1291346. Epub 2012 Jan 30.
Neuroendocrine changes in depression have long been recognized, with a focus mainly on hypercortisolism. The other hormone of the hypothalamus-pituitary adrenocortical system, aldosterone, has been widely neglected.
Here we summarize the involvement of the renin-angiotensin-aldosterone system (RAAS) and the regulation of aldosterone in health with a particular focus on sleep-related changes and its role in stress-related conditions, like major depression.
We highlight its role in functional systems which could be relevant in the therapy for refractory depression, like inflammatory mechanisms, the monoaminergic and the glutamatergic systems. Furthermore, anatomic areas which specifically mediate the action of aldosterone have been identifi ed. In particular the nucleus of the solitary tract (NTS) seems to have an important role and appears to be a target for antidepressive manipulations, like vagus nerve stimulation. Clinical data demonstrating the efficacy of aldosterone-reducing strategies for specific depressive syndromes are reviewed.
In particular aspects of differentiation between melancholic vs. atypical depression spectrum disorders are discussed.
抑郁症中的神经内分泌变化早已被认识到，主要集中在皮质醇过多症上。下丘脑-垂体-肾上腺皮质系统的另一种激素醛固酮则被广泛忽视。
在这里，我们总结了肾素-血管紧张素-醛固酮系统（RAAS）的参与以及醛固酮在健康方面的调节，特别关注与睡眠相关的变化及其在应激相关疾病（如重度抑郁症）中的作用。
我们强调了它在功能系统中的作用，这些系统在难治性抑郁症的治疗中可能是相关的，如炎症机制、单胺能和谷氨酰胺能系统。此外，还确定了具体介导醛固酮作用的解剖区域。特别是孤束核（NTS）似乎具有重要作用，并且似乎是抗抑郁药物作用的靶点，如迷走神经刺激。我们还回顾了证明醛固酮降低策略对特定抑郁综合征有效的临床数据。
特别讨论了忧郁症与非典型抑郁症谱障碍之间的区别。
