Zhao Shengnan, Zhang Bo, Sun Xueli
Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China.
Neuropsychiatr Dis Treat. 2021 May 20;17:1543-1550. doi: 10.2147/NDT.S306458. eCollection 2021.
Bipolar disorder (BD) is predominantly treated with medication, and previous studies have shown that psychotropic drugs have an effect on the neuroendocrine system. And the objectives of this study were: 1) to assess changes in neuroendocrine hormones of HPA axis and HPT axis in patients with BD after psychotropic drug treatment; 2) to determine differences in the above neuroendocrine hormones between psychotropic drug monotherapy and polytherapy treated patients.
This study was a retrospective study that included 188 subjects.
After psychotropic drugs treatment, TSH levels increased significantly from baseline (p<0.001) and FT3, TT3, FT4, TT4, ACTH and CORT levels decreased significantly from baseline (p<0.001, p<0.001, p<0.001, p=0.007, p=0.039, p=0.031). There was no significant difference in hormonal changes between the monotherapy group and the polytherapy group, even though the polytherapy group was further divided into 4 subgroups. And there was no correlation between changes in hormones and treatment duration.
Although the incidence of significant HPT axis and HPA axis dysfunction after psychotropic drug treatment is low in patients with BD who have normal baseline neuroendocrine hormone levels, psychotropic drug treatment does suppress HPT axis and HPA axis function irrespective of the use of psychotropic drugs alone or in combination, and duration of psychotropic drug treatment. Therefore, even patients with BD who have normal baseline levels of neuroendocrine hormones should have their neuroendocrine hormone levels regularly monitored after psychotropic drug medication. But, the interval of monitoring can be slightly longer, which can be once every six months after taking psychotropic drugs.
双相情感障碍（BD）主要通过药物治疗，既往研究表明精神药物对神经内分泌系统有影响。本研究的目的是：1）评估双相情感障碍患者接受精神药物治疗后下丘脑-垂体-肾上腺（HPA）轴和下丘脑-垂体-甲状腺（HPT）轴神经内分泌激素的变化；2）确定接受精神药物单一疗法和联合疗法的患者上述神经内分泌激素的差异。
本研究为回顾性研究，共纳入188名受试者。
精神药物治疗后，促甲状腺激素（TSH）水平较基线显著升高（p<0.001），游离三碘甲状腺原氨酸（FT3）、总三碘甲状腺原氨酸（TT3）、游离甲状腺素（FT4）、总甲状腺素（TT4）、促肾上腺皮质激素（ACTH）和皮质醇（CORT）水平较基线显著降低（p<0.001、p<0.001、p<0.001、p=0.007、p=0.039、p=0.031）。单一疗法组和联合疗法组之间的激素变化无显著差异，即使联合疗法组进一步分为4个亚组。并且激素变化与治疗持续时间之间无相关性。
虽然基线神经内分泌激素水平正常的双相情感障碍患者在接受精神药物治疗后发生显著HPT轴和HPA轴功能障碍的发生率较低，但精神药物治疗确实会抑制HPT轴和HPA轴功能，无论单独使用还是联合使用精神药物以及精神药物治疗的持续时间如何。因此，即使基线神经内分泌激素水平正常的双相情感障碍患者在接受精神药物治疗后也应定期监测其神经内分泌激素水平。但是，监测间隔可以稍长一些，服用精神药物后每六个月监测一次即可。
