Hennings Johannes M, Ising Marcus, Uhr Manfred, Holsboer Florian, Lucae Susanne
Translational Department, Max Planck Institute of Psychiatry, Munich, Germany.
Department of Dialectical Behavioral Therapy, kbo-Isar-Amper-Klinikum Munich-East, Munich, Germany.
Front Psychiatry. 2022 Aug 12;13:937582. doi: 10.3389/fpsyt.2022.937582. eCollection 2022.
More than 700,000 people worldwide die by suicide every year, and the number of suicide attempts is estimated as 20 times higher, most of them being associated with psychiatric disorders, especially major depression. Knowledge about effective methods for preventing suicide attempts in individuals at high risk for suicide is still scarce. Dysregulation of the neuroendocrine stress response system, ., the hypothalamic-pituitary-adrenocortical (HPA) axis, is one of the most consistent neurobiological findings in both major depression and suicidality. While the HPA axis is mostly overactive in depression, individuals with a history of suicide attempts exhibit an attenuated hormonal response to stress. It is unknown, however, whether the HPA axis is constantly attenuated in repeated suicide attempters or whether it regains normal responsivity after recovery from depression. Using the combined dexamethasone suppression/corticotropin-releasing hormone (dex/CRH) test, we assessed HPA axis regulation in acute depression ( = 237) and after recovery with respect to previous suicide attempts. Patients without previous suicide attempts show normalization of the stress hormone response to the second dex/CRH (basal ACTH response and cortisol response) after recovery from acute depression, while patients with multiple previous SA show an increased ACTH response. The change in HPA axis responsivity in patients with only one previous SA lies between the response patterns of the other groups with no change in HPA axis reactivity. Our findings suggest that patients with a history of suicide attempts belong to a subgroup of individuals that exhibit a distinct pattern of stress hormone response during acute depression and after recovery. Future studies may extend our approach by investigating additional psychological stress tasks to gain a broader understanding of the stress pathology of recurrent suicide attempters.
全球每年有超过70万人死于自杀，而自杀未遂的人数估计要高出20倍，其中大多数与精神疾病有关，尤其是重度抑郁症。关于预防自杀高风险个体自杀未遂的有效方法的知识仍然匮乏。神经内分泌应激反应系统失调，即下丘脑 - 垂体 - 肾上腺皮质（HPA）轴失调，是重度抑郁症和自杀倾向中最一致的神经生物学发现之一。虽然HPA轴在抑郁症中大多过度活跃，但有自杀未遂史的个体对应激的激素反应减弱。然而，尚不清楚HPA轴在反复自杀未遂者中是否持续减弱，或者在从抑郁症康复后是否恢复正常反应性。我们使用联合地塞米松抑制/促肾上腺皮质激素释放激素（dex/CRH）试验，评估了急性抑郁症患者（n = 237）以及康复后与既往自杀未遂情况相关的HPA轴调节情况。既往无自杀未遂史的患者在从急性抑郁症康复后，对应第二次dex/CRH的应激激素反应（基础促肾上腺皮质激素反应和皮质醇反应）恢复正常，而有多次既往自杀未遂史的患者促肾上腺皮质激素反应增加。仅有一次既往自杀未遂史的患者HPA轴反应性的变化介于其他组的反应模式之间，HPA轴反应性无变化。我们的研究结果表明，有自杀未遂史的患者属于一个亚组，该亚组个体在急性抑郁症期间和康复后表现出独特的应激激素反应模式。未来的研究可以通过研究额外的心理应激任务来扩展我们的方法，以更全面地了解反复自杀未遂者的应激病理。
