Twardowska K, Rybakowski J
Kliniki Psychiatrii Dorosłych w Poznaniu.
Psychiatr Pol. 1996 Sep-Oct;30(5):741-55.
A review of the literature has been presented concerning pathogenetic role of limbic-hypothalamic-pituitary-adrenal axis (LHPA) in depression and the therapeutic possibility obtained by influencing this axis. Increased cortisol concentration has until now been the best documented biochemical abnormality in depression. Pathological results of the Dexamethasone Suppression Test pointing to hyperactivity of LHPA axis are found in about half of depressive patients. According to most recent research, primary disturbance of LHPA axis concerns hypothalamus (excessive secretion of corticotropin releasing factory) and limbic system (insufficiency of glucocorticoid receptor). An association was found between disturbances of LHPA axis in depression and immune system abnormalities in this illness. Disturbances of serotonergic and noradrenergic neurotransmission in depression may also partially result from LHPA axis dysfunction. In recent years, the attempts have been made to use drugs acting on LHPA axis for therapeutic purposes in depression, such as ketoconazole, within the framework of antiglucocorticoid strategy. Influencing LHPA axis may underlie the mechanism of new antidepressant drug, tianeptine. Recently, it was found that classical tricyclic antidepressant drugs as well as electroconvulsive may also act on LHPA in regulatory way.
本文综述了边缘-下丘脑-垂体-肾上腺轴（LHPA）在抑郁症中的发病机制作用以及通过影响该轴所获得的治疗可能性。迄今为止，皮质醇浓度升高一直是抑郁症中记录最充分的生化异常。约半数抑郁症患者的地塞米松抑制试验病理结果显示LHPA轴功能亢进。根据最新研究，LHPA轴的原发性紊乱涉及下丘脑（促肾上腺皮质激素释放因子分泌过多）和边缘系统（糖皮质激素受体不足）。在抑郁症中，LHPA轴紊乱与该疾病的免疫系统异常之间存在关联。抑郁症中5-羟色胺能和去甲肾上腺素能神经传递的紊乱也可能部分源于LHPA轴功能障碍。近年来，在抗糖皮质激素策略的框架内，人们尝试使用作用于LHPA轴的药物（如酮康唑）治疗抑郁症。影响LHPA轴可能是新型抗抑郁药噻奈普汀作用机制的基础。最近发现，经典的三环类抗抑郁药以及电惊厥治疗也可能以调节方式作用于LHPA轴。
