시상하부-뇌하수체-부신 축과 우울증 : 임상적 의미

초록

Physiologically, hypothalamus-pituitary-adrenal axis (HPA) has effects on neuronal survival, neurogenesis, change of size, and the acquisition of new memories and the emotional appraisal of events in the brain. Although over-activity of HPA in the patients with major depressive disorder (MDD) has been reported at the rate of 20-40%, the relationship between HPA and depression has been controversial. Some evidences supported that a restoration of hyperactive HPA is the mediator for the clinical action of antidepressant drug. That is whether the hypercortisolism is a trait marker or state marker of MDD. Also clinical usefulness of dexamethasone suppression test (DST) is not clear to diagnose MDD and predict the recurrence of MDD. However, consecutive two or more DST rather than once would be useful to predict the response and remission of MDD to antideressant treatment. Furthermore, there is a possibility that HPA receptor, especially glucocorticoid receptor agonist/antagonist, is taken as a new target of pharmacological treatment for depressive disorder. These findings implicated that there might be sub-populations within patients with MDD who respond positively to DST.

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