Thakore J H, Dinan T G
Dept. of Psychological Medicine, St. Batholomew's Hospital, West Smithfield, London, UK.
Biol Psychiatry. 1995 Mar 15;37(6):364-8. doi: 10.1016/0006-3223(94)00137-R.
Evidence exists that oversecretion of cortisol may be responsible for the clinical manifestations and serotonergic abnormality in depressive illness. Using the cortisol synthesis inhibitor ketoconazole, we investigated the effects of directly lowering cortisol on the symptoms and the response of prolactin (PRL) to d-fenfluramine in eight patients suffering from major depression. Prolactin responses to d-fenfluramine were measured, and patients were treated with 400-600 mg of ketoconazole for 4 weeks, after which they were retested. Five patients treated with ketoconazole recovered from their depression, while the other three had decreases in their Hamilton Depression Rating Scale (HAMD) scores of < or = 50% and were deemed partial responders. Posttreatment prolactin responses to d-fenfluramine were higher than pretreatment values. Ketoconazole normalizes the blunted prolactin responses to d-fenfluramine and may be an effective method by which to treat depression. This implies that hypercortisolemia may be responsible for the clinical features and serotonergic subsensitivity observed in depression.
有证据表明，皮质醇分泌过多可能是导致抑郁症临床表现和血清素能异常的原因。我们使用皮质醇合成抑制剂酮康唑，对8例重度抑郁症患者进行研究，观察直接降低皮质醇水平对症状以及催乳素（PRL）对右芬氟拉明反应的影响。测量了催乳素对右芬氟拉明的反应，患者接受400 - 600毫克酮康唑治疗4周，之后再次进行检测。5例接受酮康唑治疗的患者抑郁症痊愈，另外3例汉密尔顿抑郁量表（HAMD）评分降低≤50%，被视为部分缓解者。治疗后催乳素对右芬氟拉明的反应高于治疗前值。酮康唑可使催乳素对右芬氟拉明的反应恢复正常，可能是一种有效的治疗抑郁症的方法。这意味着高皮质醇血症可能是抑郁症临床特征和血清素能亚敏感性的原因。
