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122 The APA Publishing Textbook of Mood Disorders, Second Edition
https://t.me/med1917
development of depression in susceptible patients (Schmidt and Rubinow 2009;
Schmidt et al. 2015).
Several psychotropic medications commonly prescribed for mood disorders,
chiefly antipsychotics and antidepressants, but also mood stabilizers, may affect the
HPG axis (Drobnis and Nangia 2017). Both first- and second-generation antipsychot
ics can indeed block the dopamine receptors (mainly D
prolactin, decreasing gonadotropin release. This effect is less frequent with the use of
some second-generation compounds, such as aripiprazole and cariprazine, which
have a partial agonist effect on dopamine receptors. Prolactin levels also may be increased by several antidepressants, again through their effect on dopamine (inhibition of the reuptake). Additionally, lithium has been shown to increase prolactin and
LH levels and decrease sex hormones. Anticonvulsants generally decrease free or bio
available testosterone and have variable effects on the other reproductive hormones
(Drobnis and Nangia 2017). Valproate has been clearly linked with high rates of men
strual abnormalities, hyperandrogenism, and polycystic ovary syndrome in patients
with bipolar disorder (O’Donovan et al. 2002).
As discussed, the clinical relevance of the HPG axis in mood disorders may lie in
its overlap with the HPA axis. Interestingly, the ginsenoside Rg1—one of the active
compounds of the plant genus Panax (ginseng)—has several biological functions, including sex hormone–like activities and GR modulation. Mou et al. (2017) reported
that Rg1 had antidepressant effects in mice, by modulating both the HPA and HPG
axes; specifically, mice treated with Rg1 presented significantly lessened depressivelike symptoms, together with reduced GC levels and increased testosterone levels.
) and increase the levels of
2
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Hypothalamic-Neurohypophysial System
Due to the role of the neurohypophysial system in depression and its intricate connections with other neuroendocrine and immune pathways, it is not surprising that
AVP and OT have been studied for their therapeutic potential. Antagonists of the
AVP receptor V1b have been demonstrated to have antidepressant effects (Neumann
and Landgraf 2012). However, Griebel et al. (2012) reported results from three ran
domized, double-blind, placebo-controlled studies of patients with depression who
were taking SSR149415—an AVP V1b receptor antagonist—for 8 weeks, with no uni
vocal results. Of note, SIADH could be caused by several drugs commonly prescribed
for mood disorders, such as many antidepressants (mainly SSRIs, but also tricyclics,
monoamine oxidase inhibitors, and venlafaxine) and anticonvulsants (e.g., valproic
acid, carbamazepine, oxcarbazepine) (Liamis et al. 2008; Spasovski et al. 2014). Even
if the precise mechanisms have not been completely clarified, SIADH could be due to
an increase in ADH secretion caused by 5-HT and norepinephrine (De Picker et al.
2014) or to a direct effect on renal sensitivity to ADH (Sachdeo et al. 2002).
Preclinical and clinical evidence indicate that OT, administered either peripherally
or centrally, may counteract depression (Matsuzaki et al. 2012; Neumann and Landgraf 2012). These antidepressant effects are not blocked by the administration of an OT
receptor antagonist (Acevedo-Rodriguez et al. 2015), suggesting that they are differ
ently mediated, probably through the AVP receptors (Manning et al. 2012). Interestingly, OT could exert an antidepressant effect by increasing dopaminergic transmission,
via D
receptor activation, in the medial prefrontal cortex (Li et al. 2020). The adminis-
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123 Psychoneuroendocrinology of Mood Disorders
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tration of OT to prevent postpartum depression is still under debate. Some studies
found that OT may negatively impact maternal mood (Kroll-Desrosiers et al. 2017;
Mah 2016), although other evidence suggests a protective role for future development
of postpartum depression, even without immediate effects on maternal mood (Takács
et al. 2019).
Conclusion
Mood disorders are profoundly linked to biological alterations in the body. We should
therefore think of mental health as a part of the whole individual’s well-being. The
human organism is a complex orchestra in which all the instruments play together in
order to maintain homeostasis; an imbalance within one system could cause the disruption of others. Through the investigation of the interface between body and mind,
psychoneuroendocrinology provides a broader perspective for approaching mental
health. Even though current findings are not definitive and some critical issues remain, research in this field may shed light on the biological mechanisms underpinning mood disorders, identify new paths for diagnosis and treatment, and ultimately
lead to delivery of better patient care.
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