SYMPOSIA

Bulletin of Clinical Psychopharmacology, Vol: 21, Supplement: 2, 2011 - www.psikofarmakoloji.org
Abstracts of the Invited Speakers
(4-9). One percent of thyrotoxic patients are suggested to have been first diagnosed with a psychiatric disease (5). Interestingly, it
seems that both hyperthyroism and hypothyroidism could lead to mania, anxiety or schizophrenic symptoms. The underlying reason
for the co-occurrence of thyroid diseases and psychiatric disorders is not yet known. However, in these cases, combined hormonal and
psychotropic interventions may improve symptoms.
Several studies have assessed HPT axis activity in various psychiatric disorders, especially mood disorders and anxiety disorders. Up
to 45% of the euthyroid patients with major depression showed blunted TSH response to TRH stimulation (10). Moreover, thyroid
hormones accelerate the antidepressant effect of tricyclic antidepressants (11). HPT axis alterations may play an important role in the
pathophysiology of bipolar disorder, but this area has received much less attention than major depressive disorder. However, it seems
that abnormalities of this axis are not uncommon among bipolar patients, especially among the rapid cycling subgroup. So far, thyroid
dysfunctions such as hypothyroidism and exaggerated TSH response to TRH have been found in rapid cycling patients (12,13). In some
bipolar patients, latent thyroid dysfunction becomes overt by lithium treatment. Moreover, it has been suggested in a recent study that
bipolar disorder itself may cause increased thyroid volumes and decreased thyroid hormones as well as lithium treatment in patients (14).
Few studies have investigated possible thyroid dysfunctions in psychotic patients. In a study, schizophrenic patients showed increased
serum T4 levels, which normalized after antipsychotic treatment. Elevated serum T4 levels in schizophrenic patients may suggest an
impairment of T4 metabolism in the brain (4).
A few studies of panic disorder have demonstrated evidence of a blunted TSH response to TRH. A previous study showed higher TSH
levels in non-medicated patients with severe panic attacks (7). Increased TSH levels seen in patients with panic disorder might be due to
reduced intracerebral 5-HT concentrations (15).
Eletroconvulsive therapy (ECT) itself may affect the HPT axis as do psychotropic drugs. In a previous study, elevated TSH levels were found
following ECT in depressed patients. This response might contribute to the therapeutic effect of ECT (16).
In conclusion, the HPT axis and thyroid hormones play an important role in the pathophysiology of many psychiatric disorders. However,
further well-designed studies are needed to clarify the confusion in this field.
Key words: Hypothalamic-pituitary-thyroid axis, thyroid hormones, psychiatric disorders
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S76-7
Sex steroids and psychiatric disorders
Erdem Deveci
Regional Training and Research Hospital, Department of Psychiatry, Erzurum, Turkey
E-mail: erdemdeveci@gmail.com
Sex steroids play very important roles in the development and function of the central nervous system and have long been known to
exert powerful effects on brain differentiation, neural plasticity, central neurotransmission and behavior. Estrogens, progestins, and
androgens are able to induce several effects in brain areas of the central nervous system, through binding with specific receptors (1).
Sex steroid hormones act through genomic mechanisms, modulating synthesis, release and metabolism of many neuropeptides and
neurotransmitters, and through non-genomic mechanisms, influencing electrical excitability, synaptic function, morphological features
and neuron-glia interactions (2).
Animal research has shown that estrogens, progesterone and testosterone are critically involved in myelination, forming the basis of white
matter connectivity in the central nervous system. Animal studies have also provided evidence that estrogen modulates dopaminergic
activity and affects dopamine related behaviors in animals in a variety of ways.
Clinical observations suggest that sex steroids have potent effects on mood, mental state and cognitive functions. Data also suggest
that estrogen has a pivotal role in modulating other neurotransmitter systems such as serotonergic and glutamatergic systems that
have implications for schizophrenia and mood disorders (3,4). Sex steroid deficiency causes many neuroendocrine changes. At the
hypothalamic level, estrogen withdrawal gives rise to vasomotor symptoms, eating behavior disorders, and altered blood pressure
control. On the other hand, at the limbic level, the changes in serotoninergic, noradrenergic and opioidergic tones contribute to
modifications in mood, behavior and nociception.
Studies of testosterone concentrations in depression have yielded inconsistent results reporting low as well as high testosterone levels
associated with depression (5). On the other hand anabolic steroid use has increased in prevalence in many countries over the past
decade, and it can lead to aggression, depression, mania and psychosis, in addition to a range of physical complications which seem to
be important in clinical practice (6).
Key words: Depression, estrogen, mood disorders, progesterone, schizophrenia, testosterone
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