Jiang Xiaoling, Zhong Wen, An Haiyan, Fu Mingyu, Chen Yuanyuan, Zhang Zhenggang, Xiao Zhongju
Department of Epidemiology, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangdong 510515, China.
Department of Physiology, Key Laboratory of Psychiatric Disorders of Guangdong Province, School of Basic Medical Sciences, Southern Medical University, Guangdong 510515, China.
J Affect Disord. 2017 Jun;215:118-124. doi: 10.1016/j.jad.2017.03.013. Epub 2017 Mar 16.
In recent years, a relationship between depression and basal dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEA-S) levels has frequently been suggested, but responses of these adrenal steroids to psychosocial stress have not been examined in individuals with depressive disorders. In this study, we examined salivary DHEA, DHEA-S, and cortisol/DHEA response to the Trier Social Stress Test (TSST) in individuals with depressive disorders and in healthy controls to discover whether the responses of DHEA and DHEA-S to acute psychosocial stress could be a more sensitive marker of HPA dysfunction in depressive disorders.
We compared salivary cortisol, DHEA, DHEA-S, and cortisol/DHEA levels to the TSST tests between 38 individuals with depression and 43 healthy controls aged 18.4-25.9 years. Depression severity was assessed by the self-reported Beck Depression Inventory-II (BDI-II). Salivary samples were evaluated at four time points: the baseline (-10 time point), before the TSST started (0 time point), the end of the TSST (+20 time point), and the recovery (+50 time points).
No significant differences existed in the basal adrenal hormonal levels between subjects with depressive disorders and controls; however, at the end of TSST, attenuated DHEA and DHEA-S response was identified in subjects with depressive disorders compared to that found in healthy subjects. The differences in the DHEA and DHEA-S levels at the +20 time point, as well as the differences in the cortisol/DHEA at the +50 time point, exhibited negative correlations with depression severity.
Attenuated DHEA and DHEA-S response to acute psychosocial stress was identified in subjects with depressive disorders. These findings help us to discover the bi-directional relationship between depression and the hypothalamic-pituitary-adrenal (HPA) axis function, hence furthering our understanding of whether altered DHEA and DHEA-S response to psychosocial stress may be a more sensitive method than basal adrenal steroid analysis for detecting HPA axis dysfunction in depressive disorders.
As this is a case control study, we could only draw the conclusion of the bi-directional relationship between the depression and the altered DHEA (S) response to stress, and could not identify whether depression was due to the HPA dysfunction, or vice versa. Prospective studies such as such as cohort studies or epidemiology experiments are needed to further test the cause of depression or HPA dysfunction; and the mechanisms responsible for altered DHEA and DHEA-S in response to acute psychosocial stress in individuals with depressive disorders are also needed to be clarified.
近年来，抑郁症与基础脱氢表雄酮（DHEA）及硫酸脱氢表雄酮（DHEA-S）水平之间的关系常被提及，但这些肾上腺类固醇对心理社会应激的反应在抑郁症患者中尚未得到研究。在本研究中，我们检测了抑郁症患者和健康对照者唾液中DHEA、DHEA-S以及皮质醇/DHEA对特里尔社会应激测试（TSST）的反应，以探究DHEA和DHEA-S对急性心理社会应激的反应是否可能是抑郁症中下丘脑-垂体-肾上腺（HPA）功能障碍更敏感的标志物。
我们比较了38名年龄在18.4 - 25.9岁的抑郁症患者和43名健康对照者在TSST测试中的唾液皮质醇、DHEA、DHEA-S以及皮质醇/DHEA水平。通过自我报告的贝克抑郁量表第二版（BDI-II）评估抑郁严重程度。在四个时间点采集唾液样本：基线（-10时间点）、TSST开始前（0时间点）、TSST结束时（+20时间点）以及恢复阶段（+50时间点）。
抑郁症患者和对照组的基础肾上腺激素水平无显著差异；然而，在TSST结束时，与健康受试者相比，抑郁症患者DHEA和DHEA-S反应减弱。+20时间点DHEA和DHEA-S水平的差异以及+50时间点皮质醇/DHEA的差异与抑郁严重程度呈负相关。
在抑郁症患者中发现DHEA和DHEA-S对急性心理社会应激的反应减弱。这些发现有助于我们发现抑郁症与下丘脑-垂体-肾上腺（HPA）轴功能之间的双向关系，从而进一步了解DHEA和DHEA-S对心理社会应激反应的改变是否可能是一种比基础肾上腺类固醇分析更敏感的方法来检测抑郁症中的HPA轴功能障碍。
由于这是一项病例对照研究，我们只能得出抑郁症与DHEA（S）对应激反应改变之间的双向关系的结论，无法确定抑郁症是否由HPA功能障碍引起，反之亦然。需要进行前瞻性研究，如队列研究或流行病学实验，以进一步测试抑郁症或HPA功能障碍的原因；还需要阐明抑郁症患者中DHEA和DHEA-S对急性心理社会应激反应改变的机制。
