HPA AXIS FUNCTION, NEUROIMAGING & ESTROGEN AUGMENTATION IN DEPRESSED WOMEN

许多抑郁症患者存在应力轴的激活。此外，通过脑成像发现抑郁症患者大脑阿片受体的变化。应激激素和阿片受体均参与生殖轴激素的调节。在这项研究中，我们感兴趣的是这两个生物系统与标准抗抑郁药氟西汀的治疗反应之间的联系，以及雌激素在改变抗抑郁药反应方面的作用。在基线时，我们将使用甲替拉酮评估应激轴，并通过PET成像检查使用[11C]-卡芬太尼的脑阿片受体。在这些研究之后，女性将在6周结束时参加氟西汀的6周试验，对治疗没有完全反应的人将被随机分成接受雌激素增强剂或安慰剂的额外4周。

Activation of the stress axis is present in a number of patients with depression. In addition alterations in brain opioid receptors in depressed patients has been found by brain imaging. Both stress hormones and opioid receptors are involved in the regulation of reproductive axis hormones. In this study, we are interested in the links between these two biological systems and treatment response to a standard antidepressant, fluoxetine, and the effects of estrogen in altering the response to antidepressants. At baseline we will evaluate the stress axis with the use of metyrapone, and examine brain opioid receptors with [11C]-carfentanil by PET imaging. Following these studies, women will be enrolled in a 6 week trial of fluoxetine At the end of 6 weeks, individuals who have not fully responded to treatment, will be randomized to receive either estrogen augmentation or placebo for an additional 4 weeks.