Transcript CFS patients receiving DHEA as add

PSYCHIATRIC or
PSYCHOPHARMACOLOGICAL
EFFECTS OF HORMONES
ANDREA MARQUEZ LOPEZ MATO
INSTITUTE OF BIOLOGICAL PSYCHIATRY
BUENOS AIRES. ARGENTINA
www.ipbi.com.ar
The author declares to have
no conflicts of interest,
including any financial, personal
or other relationship
with other people or organizations
that could have
inappropriately influenced her work
PSYCHIATRIC EFFECTS OF
HORMONES
• The objetive of this presentation is to
show that hormones used as add-on drugs
may have psychopharmacological effects in
different psychiatric entities
• We present some clinical data from 15
years of work at the Institute of Biological
Psychiatry (ipbi), Buenos Aires, Argentina
GROUP I
•Unipolar and bipolar TR depressive patients
receiving thyroid hormone as add-on therapy
GROUP II
•Females with menopausal depression receiving
estrogen, progestins, tibolone, soy bean
GROUP III
•Andropausic patients receiving DHEA
GROUP IV
•CFS patients receiving DHEA
I- Unipolar and bipolar TR
depressives receiving thyroid
hormone as an add-on therapy
• I a Treatment refractory unipolar depressive
patient on add-on therapy with T3
• II b Treatment refractory “rapid cycling”
bipolar depressive patients on add-on
therapy with T4
Ia- Unipolar Treatment Refractory
depressives receiving thyroid hormone as
add-on therapy
RATIONALE
• Treatment-resistant depressed women, may have
a high frequency of serum thyroxine levels near
the lower limit of normal; who only respond after
T3 was added to their antidepressant regime
• Low dose (5-50 mg/d) T3 "augmentation therapy"
is the best documented treatment with thyroid
hormones in depression
Ia- Unipolar Treatment Refractory
depressives receiving thyroid hormone
as add-on therapy
RATIONALE (cont)
• STAR D The lower side effect burden and
ease of use of T3 (50 µgs) augmentation
suggest that it has slight advantages over
lithium (900mgs) augmentation for depressive
patients who have had several failed
medication
Ia- Unipolar Treatment Refractory
depressives receiving thyroid hormone
as add-on therapy
•
•
•
•
120 patients mostly female
TRD for at least 2 years
20% had blunted response to TRHST
(trait marker for UD)
50-150 µgs/d of triodothyronine was
administered with ATD therapy
Ia- Unipolar Treatment Refractory
depressives receiving thyroid hormone
as add-on therapy
• 79% had a good response to new strategy
within first three months
• Measured by
• Clinical evaluation
• Subjective impression
• Beck or HAMD inventory
• Remission rates do not significately differenciate
from control groups not receiving T3
• T3 is a good add-on therapy for TRD
Unipolar Treatment Refractory
depressives receiving thyroid hormone
as add-on therapy
80
70
60
50
40
30
20
10
0
response
remission
Ib- Treatment refractory “rapid cycling”
bipolar depressive patients on add-on
therapy with T4
RATIONALE
• High-dose (250-500 micrograms/d) T4 is a well
documented therapy for "rapid cycling bipolar
disorder” refractory to lithium
Ib- Treatment refractory “rapid cycling”
bipolar depressive patients on add-on
therapy with T4
• 34 patients (80% females)
• Treatment refractory to various drugs
(including lithium)
• Medicated with lamotrigine, valproic acid
and/or oxcarbamacepine
• 33% had hiperresponsiveness to TRH
stimulus (state marker)
Ib- Treatment refractory “rapid cycling”
bipolar depressive patients on add-on
therapy with T4
90% responded
Measured by
• Clinical evaluation
• Subjective impression
• Beck inventory or HAMD
Improved remission rates
Cycle switch was less evident
Ib- Treatment refractory “rapid cycling”
bipolar depressive patients on add-on
therapy with T4
90
80
70
60
50
40
30
20
10
0
response
less switching
in 5 years
II- Females with menopausal
depression receiving estrogen,
progestin, tibolone, soy bean
• IIa - Females with menopausal depression receiving
soy bean natural supplements
• IIb - Females with menopausal depression receiving
tibolone (STEARS)
• IIc - Females with menopausal depression receiving
combined HRT with different form of progestins
II- Females with menopausal depression
receiving estrogen, progestin, tibolone, soy
bean
RATIONALE
• Ovarian steroids have widespread effects
throughout the brain on serotonin pathways,
catecholaminergic neurons, and the basal
forebrain cholinergic system
• Ovarian steroids have measurable effects on
affective state as well as cognition
II- Females with menopausal depression
receiving estrogen, progestin, tibolone,
soy bean
ARGENTINA TREATMENTS
IIa- 50 patients receiving ATD therapy with
or without soybean preparations
Percentage of improved
patients
90
80
70
60
50
40
30
ATD plus
Soy bean
derivates
20
10
0
Response (HAMD 6 weeks)
No remission evaluated
ATD alone
IIb- Female MDD receiving ATD therapy with
(140) or without tibolone (77)
95%
95
90
Improvement 85
80%
80
75
ATD
plus
tibolone
70
Response (HAMD 6 weeks)
No remission evaluated
ATD alone
Improvement in depression
IIc- 120 patients receiving combined HRT
with different forms of progesterone
70
60
50
RTH with
56%PG
Natural
40
30
20
RHT with
MedroxiPG
RTH32%
with
any
progestins
10
0
Response defined by HAMD and clinical evaluation
III- PADAM patients receiving DHEA
supplements
RATIONALE
• DHEA is a precursor hormone which counteracts
the aging and immuno-suppressive effects
caused by corticosteroids
• Supplementing DHEA has been shown to have
anti-obesity effects, antiaging properties and
stabilization of neurotrasmision
III- PADAM patients receiving DHEA
supplements
RATIONALE (cont)
• Several studies adress the benefits of a longterm (1 year), medium dose of 50- 100 mgs/d
replacement therapy in different groups of aging
men who presented clinical characteristics of
partial androgen deficiency (PADAM)
III- PADAM patients receiving DHEA
supplements
•
•
•
•
•
44 patients
HAM D ≥ 15
Receiving several ATD therapies
21 received ATD alone
23 received DHEA suplementation
III PADAM patients receiving DHEA
supplements
76%
80
70
48%
60
Clinical
Improvement
50
40
DHEA
30
20
10
0
No DHEA
IV - CFS patients receiving DHEA
RATIONALE
• Chronic Fatigue Syndrome (CFS) is
characterized by a persistent debilitating
fatigue, muscle & joint related symptoms and
neuropsychiatric symptoms
• Pathogenesis is associated with abnormalities
of the endocrine system with impairment of the
adrenal axis response
IV- CFS patients receiving DHEA
RATIONALE
• Majority of patients with CFS have a serum
cortisol and dehydroepiandrosterone sulfate
(DHEA-S) deficiency which might be related to
the neuropsychiatric symptoms
IV- CFS patients receiving DHEA as
add-on therapy
200 patients receiving:
• Pregabalin alone
• Pregabalin plus duloxetine
• Pregabalin plus duloxetine plus DHEA
CFS patients receiving DHEA as add-on therapy
Clinical
Improvement
Ferran Scale
80
Duloxetine: 60 /120 mgs
Pregabalin:150/450 mgs
DHEA 100/200 mgs
Duloxetine
78
76
74
72
Duloxetine
plus
pregabalin
70
68
66
64
Duloxetine
Plus
pregabalin
plus DHEA
PSYCHOPHARMACOLOGICAL
EFFECTS OF HORMONES
DISCUSSION BEFORE CONCLUSIONS
• All patients received treatment on a clinical
open basis
• Patients were evaluated by different
physicians over time
• Hormonal replacement or add-on treatments
may be off the label indications in some
cases
• Results must be reproduced in placebocontrolled studies
PSYCHOPHARMACOLOGICAL
EFFECTS OF HORMONES
CONCLUSIONS
Hormones or endocrine enhancers
can boost or augment
psychopharmalogical
action of drugs by direct action on the
receptors or as an add-on effect.
THANK YOU
ANDREA MARQUEZ LOPEZ MATO
INSTITUTE OF BIOLOGICAL PSYCHIATRY
BUENOS AIRES. ARGENTINA
www.ipbi.com.ar
www.aapb.org.ar