Duval Fabrice, Mokrani Marie-Claude, Danila Vlad, Erb Alexis, Gonzalez Lopera Felix, Tomsa Mihaela
Pôle 8/9-APF2R, Centre Hospitalier, 68250 Rouffach, France.
Brain Sci. 2022 May 10;12(5):621. doi: 10.3390/brainsci12050621.
Involvement of the dopaminergic (DA) and hypothalamic-pituitary-thyroid (HPT) systems in suicidal behavior is still poorly understood. We assessed multihormonal responses to apomorphine (APO; a short acting DA receptor agonist) and 8 AM and 11 PM protirelin (TRH) tests in 30 medication-free DSM-5 euthyroid major depressed inpatients with suicidal behavior disorder (SBD) (current, = 14; in early remission, = 16) and 18 healthy hospitalized control subjects (HCs). Compared to HCs, responses to APO and TRH tests were unaltered in SBDs in early remission. However, current SBDs exhibited increased APO-induced growth hormone (GH) and adrenocorticotropin (ACTH) stimulation, and reduced 11 PM thyrotropin (TSH) and ∆∆TSH values (difference between 11 PM and 8 AM TRH-TSH responses). In current SBDs, the association between high APO-GH concentrations and low ∆∆TSH values was more common in recent suicide attempters than in past suicide attempters. These preliminary results suggest that co-occurring alterations in the DA and HPT systems (i.e., DA receptor hyperresponsiveness associated with decreased hypothalamic TRH drive) may contribute to the pathophysiology of suicidal behavior. Conversely, normalization of DA and TRH functions might reflect a process of recovery from suicidality. Thus, our findings suggest that drugs targeting the DAergic and TRH systems could be relevant in suicide prevention.
多巴胺能（DA）系统和下丘脑 - 垂体 - 甲状腺（HPT）系统在自杀行为中的作用仍未得到充分理解。我们评估了30名无药物治疗的DSM - 5甲状腺功能正常的重度抑郁伴自杀行为障碍（SBD）的住院患者（目前有自杀行为的14例，处于早期缓解期的16例）和18名健康住院对照者（HCs）对阿扑吗啡（APO；一种短效DA受体激动剂）以及上午8点和晚上11点促甲状腺素释放激素（TRH）试验的多激素反应。与HCs相比，处于早期缓解期的SBD患者对APO和TRH试验的反应未改变。然而，目前有自杀行为的患者表现出APO诱导的生长激素（GH）和促肾上腺皮质激素（ACTH）刺激增加，以及晚上11点促甲状腺激素（TSH）和∆∆TSH值（晚上11点与上午8点TRH - TSH反应之间的差异）降低。在目前有自杀行为的患者中，高APO - GH浓度与低∆∆TSH值之间的关联在近期自杀未遂者中比在既往自杀未遂者中更常见。这些初步结果表明，DA和HPT系统同时出现的改变（即DA受体反应性过高与下丘脑TRH驱动降低相关）可能导致自杀行为的病理生理学。相反，DA和TRH功能的正常化可能反映了从自杀倾向中恢复的过程。因此，我们的研究结果表明，针对DA能和TRH系统的药物可能与自杀预防相关。
