HPA axis reactivity to pharmacologic and psychological stressors in euthymic women with histories of postpartum versus major depression.
HPA axis reactivity to pharmacologic and psychological stressors in euthymic women with histories of postpartum versus major depression.
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DOI：
10.1007/s00737-017-0716-y
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发表时间：
2017-06
期刊：
影响因子：
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通讯作者：
Meltzer-Brody S
中科院分区：
文献类型：
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作者：
Ferguson EH;Di Florio A;Pearson B;Putnam KT;Girdler S;Rubinow DR;Meltzer-Brody S
有产后抑郁症（PPD）病史的女性是否像重度抑郁症（MDD）中报道的那样存在残留的、异常的下丘脑-垂体-肾上腺（HPA）轴反应性尚不清楚。进一步不清楚的是，与重度抑郁症相关的HPA轴反应性异常是一种稳定的、潜在的易感性还是一种状态依赖现象。本研究的目的如下：1)确定有抑郁史的产后健康妇女对药理学和心理挑战是否有异常的HPA轴反应；2)比较有产后抑郁史和重度抑郁史妇女的HPA反应。作为次要目标，我们想要确定创伤史对下丘脑轴功能的影响。45例已产（产后12-24个月）、患有重度抑郁症（MDD）、PPD （PPD）和对照组（n=15）的健康女性在黄体期完成了药理学（地塞米松/CRH试验[DEX/CRH]）和心理（特里尔社会压力测试[TSST]）挑战。结果测量DEX/CRH后皮质醇和促肾上腺皮质激素（ACTH）的反应，以及TSST期间血压、心率、肾上腺素、去甲肾上腺素和皮质醇的反应。所有组对DEX/CRH和TSST均有较强的皮质醇和ACTH反应。各组皮质醇或ACTH对DEX/CRH的反应，血压、心率、肾上腺素、去甲肾上腺素或皮质醇对TSST的反应均无显著差异。各组间皮质醇/ACTH比值无显著差异。创伤史与有重度抑郁症病史的女性对DEX/CRH的皮质醇反应降低相关，经校正后无显著性差异（F8,125, p=0.02， Greenhouse-Geisser校正p= 0.11）。目前，患有重度抑郁症或产后抑郁症病史的健康女性在给予药理学或心理应激源后没有表现出残余的异常应激反应。
It is unclear whether women with a history of postpartum depression (PPD) have residual, abnormal hypothalamic-pituitary-adrenal (HPA) axis reactivity, as has been reported in major depression (MDD). Further unclear is whether the abnormalities in HPA axis reactivity associated with MDD represent a stable, underlying predisposition or a state-dependent phenomenon. This study sought the following: 1) to determine if euthymic postpartum women with a history of depression have an abnormal HPA axis reactivity to pharmacologic and psychological challenges and 2) to compare HPA reactivity in women with histories of PPD versus MDD. As a secondary objective, we wanted to determine the influence of trauma history on HPA axis function. Forty-five parous (12–24 months postpartum), euthymic women with history of MDD (n=15), PPD (n=15) and controls (n=15) completed pharmacologic (dexamethasone/CRH test [DEX/CRH]) and psychological (Trier Social Stress Test [TSST]) challenges during the luteal phase. Outcome measures were cortisol and adrenocorticotropic hormone (ACTH) response after DEX/CRH, and blood pressure, heart rate, epinephrine, norepinephrine, and cortisol response during the TSST. All groups had robust cortisol and ACTH response to DEX/CRH and cortisol response to TSST. Groups did not differ significantly in cortisol or ACTH response to DEX/CRH or in blood pressure, heart rate, epinephrine, norepinephrine, or cortisol response to TSST. Cortisol/ACTH ratio did not differ significantly between groups. Trauma history was associated with decreased cortisol response to DEX/CRH in women with histories of MDD, which was not significant after correction (F8,125, p=0.02, Greenhouse-Geisser corrected p= 0.11). Currently euthymic women with histories of MDD or PPD did not demonstrate residual abnormal stress responsivity following administration of either a pharmacologic or psychological stressor.