Duncan G E, Knapp D J, Carson S W, Breese G R
UNC Neuroscience Center, Department of Psychiatry, University of North Carolina at Chapel Hill, USA.
J Pharmacol Exp Ther. 1998 May;285(2):579-87.
Hypersecretion of cortisol occurs in numerous patients with major depression and normalizes with clinical recovery during the course of chronic antidepressant treatment. These clinical data suggest that investigation of the effects of antidepressant treatments on the regulation of the brain-pituitary-adrenal axis may assist in elucidating the therapeutic basis of antidepressant actions. In the present investigation, both swim stress and acute fluoxetine challenge increased release of corticosterone and progesterone to reflect an activation of the brain pituitary-adrenal axis. The effects of chronic antidepressant treatment (21 days) on corticosterone and progesterone secretion induced by these challenges were investigated. Chronic fluoxetine treatment (5 mg/kg/day) completely blocked the increased secretion of corticosterone and progesterone in response to the acute fluoxetine challenge. Chronic treatment with desipramine, imipramine or amytriptyline (15 mg/kg/day) also markedly attenuated fluoxetine-induced corticosterone and progesterone secretion. However, chronic treatment with the monoamine oxidase inhibitors, phenelzine (5 mg/kg) and tranylcypromine (5 mg/kg), did not affect this hormonal response to acute fluoxetine challenge. Plasma levels of fluoxetine after acute challenge were not significantly different for the various chronic antidepressant treatment conditions from the chronic saline controls; therefore, an increase in the metabolism of fluoxetine can not explain the antagonism of the fluoxetine-induced hormonal response after chronic antidepressant treatment. In contrast to the effects of selected antidepressants on acute fluoxetine-induced steroid release, chronic treatment with imipramine (20 mg/kg/day), fluoxetine (5 mg/kg/day) or phenelzine (5 mg/kg) did not significantly alter this swim stress-induced corticosterone or progesterone secretion. Because chronic fluoxetine and tricyclic antidepressant drugs blocked the acute action of fluoxetine to increase adrenal cortical secretion, but did not alter swim stress-induced secretion of these steroids, we propose that distinct neurochemical mechanisms control fluoxetine and swim stress-induced steroid release. We speculate that the substantial adaptive response to those chronic antidepressant treatments, which minimize the effect of acute fluoxetine challenge to increase in corticosterone and progesterone secretion, may be relevant to the therapeutic actions of these drugs.
许多重度抑郁症患者存在皮质醇分泌过多的情况,且在慢性抗抑郁治疗过程中随着临床康复而恢复正常。这些临床数据表明,研究抗抑郁治疗对脑-垂体-肾上腺轴调节的影响可能有助于阐明抗抑郁作用的治疗基础。在本研究中,游泳应激和急性氟西汀激发均增加了皮质酮和孕酮的释放,以反映脑垂体-肾上腺轴的激活。研究了慢性抗抑郁治疗(21天)对这些激发所诱导的皮质酮和孕酮分泌的影响。慢性氟西汀治疗(5毫克/千克/天)完全阻断了急性氟西汀激发所引起的皮质酮和孕酮分泌增加。用去甲丙咪嗪、丙咪嗪或阿米替林(15毫克/千克/天)进行慢性治疗也显著减弱了氟西汀诱导的皮质酮和孕酮分泌。然而,用单胺氧化酶抑制剂苯乙肼(5毫克/千克)和反苯环丙胺(5毫克/千克)进行慢性治疗并未影响对急性氟西汀激发的这种激素反应。急性激发后,各种慢性抗抑郁治疗条件下的氟西汀血浆水平与慢性生理盐水对照组相比无显著差异;因此,氟西汀代谢增加无法解释慢性抗抑郁治疗后对氟西汀诱导的激素反应的拮抗作用。与所选抗抑郁药对急性氟西汀诱导的类固醇释放的影响相反,用丙咪嗪(20毫克/千克/天)、氟西汀(5毫克/千克/天)或苯乙肼(5毫克/千克)进行慢性治疗并未显著改变这种游泳应激诱导的皮质酮或孕酮分泌。由于慢性氟西汀和三环类抗抑郁药阻断了氟西汀增加肾上腺皮质分泌的急性作用,但未改变游泳应激诱导的这些类固醇分泌,我们提出不同的神经化学机制控制氟西汀和游泳应激诱导的类固醇释放。我们推测,对那些慢性抗抑郁治疗的显著适应性反应,即最大限度地减少急性氟西汀激发增加皮质酮和孕酮分泌的作用,可能与这些药物的治疗作用有关。