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Hormonas como Psicofármacos
Hormonas como Psicofármacos
Hormonas como Psicofármacos
Hormonas como Psicofármacos
Hormonas como Psicofármacos
Hormonas como Psicofármacos
Hormonas como Psicofármacos
Hormonas como Psicofármacos
Hormonas como Psicofármacos
Hormonas como Psicofármacos
Hormonas como Psicofármacos
Hormonas como Psicofármacos
Hormonas como Psicofármacos
Hormonas como Psicofármacos
Hormonas como Psicofármacos
Hormonas como Psicofármacos
Hormonas como Psicofármacos
Hormonas como Psicofármacos
Hormonas como Psicofármacos
Hormonas como Psicofármacos
Hormonas como Psicofármacos
Hormonas como Psicofármacos
Hormonas como Psicofármacos
Hormonas como Psicofármacos
Hormonas como Psicofármacos
Hormonas como Psicofármacos
Hormonas como Psicofármacos
Hormonas como Psicofármacos
Hormonas como Psicofármacos
Hormonas como Psicofármacos
Hormonas como Psicofármacos
Hormonas como Psicofármacos
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Hormonas como Psicofármacos

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  • NOTE • A recent meta-analysis of studies investigating the effect of various hormone replacement therapies on menopausal depR & Dsed mood found progestogen alone to have the least effect on mood (effect size 0.39) and androgen alone to have the greatest effect (effect size 1.37). The authors concluded that most of the studies included in the analysis used adequate sample sizes, random assignments, double-blind treatment manipulations and were valid and reliable measuR & D of depR & Dsion. They concluded that HRT was effective in reducing depR & Dsed mood among menopausal women, but that androgen therapy had the greatest effect 1 . The meta-analysis was not able to evaluate any dose effect because of the different forms of treatment used in the various studies, which were not directly comparable. At this moment in time, only broad conclusions can be reached and the authors of this study comment that many important questions remain to be evaluated 1 . Reference 1. Zweifel JE, O'Brien WH. A meta-analysis of the effect of hormone replacement therapy upon depR & Dsed mood. Psychoneuroendocrinology 1997;22:189–212
  • Remission Lower Risk of a Relapse Patients who achieve symptom remission are far less likely to have a relapse. Furthermore, those achieve symptom remission and do relapse, do so later in the course than those with R & Didual symptoms (Judd et al. 1998, Van London et al. 1998).
  • Key Point: Remission rates were statistically significantly greater for duloxetine than for fluoxetine or placebo by mixed models repeated measuR & D (MMRM) analysis. Background: The data pR & Dented here are from one of two identical but independent 8-week, randomized, double-blind, placebo-controlled, phase II studies in adult outpatients (18-65 years of age) who met DSM-IV criteria for major depR & Dsive disorder (MDD). The duloxetine dose was titrated in the first 3-weeks from 40 mg/day to 120 mg/day (60 mg BID). None of the patients were considered treatment-refractory. Entry criteria included a DSM-IV diagnosis of major depR & Dsion with a severity specified by a 17-item Hamilton DepR & Dsion Rating Scale (HAMD-17) total score > 15 and a Clinical Global ImpR & Dsion of Severity (CGI-S) score of > 4 (indicating at least moderately ill) at baseline.The relatively low cut-off of 15 on the 17-item HAMD was chosen to minimize encouraging raters to artificially inflate baseline scoR & D, to provide greater accuracy. Note that all patients still had to meet full DSM-IV criteria for MDD and have a CGI-S > 4. References: Goldstein DJ, Mallinckrodt C, Lu Y, Demitrack MA. Duloxetine in the Treatment of Major DepR & Dsive Disorder: A Double-Blind Clinical Trial. J Clin Psychiatry. 2002;63(3):225-231. Data: % Duloxetine 120 mg per day (n = 66) 56 Fluoxetine 20 mg QD (n = 33) 30 Placebo (n-68) 32 Study: F1J-MC-HMAQ (A)
  • Remission Lower Risk of a Relapse Patients who achieve symptom remission are far less likely to have a relapse. Furthermore, those achieve symptom remission and do relapse, do so later in the course than those with R & Didual symptoms (Judd et al. 1998, Van London et al. 1998).
  • Transcript

    • 1. PSYCHIATRIC or PSYCHOPHARMACOLOGICAL EFFECTS OF HORMONES ANDREA MARQUEZ LOPEZ MATO INSTITUTE OF BIOLOGICAL PSYCHIATRY BUENOS AIRES. ARGENTINA www.ipbi.com.ar
    • 2. Ia- Unipolar Treatment Refractory depressives receiving thyroid hormone as add-on therapy <ul><li>JUST REMEMBER </li></ul><ul><li>T4 is the predominant hormone released with the majority of T3 being formed in the periphery by enzymatic deiodination. </li></ul><ul><li>T3 &amp;T4 have widespread effects increasing oxygen consumption and carbohydrate absorption, regulating growth and maturation (especially of the CNS) and decreasing cholesterol levels. </li></ul>
    • 3. <ul><li>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 </li></ul>
    • 4. PSYCHIATRIC EFFECTS OF HORMONES <ul><li>The objetive of this presentation is to </li></ul><ul><li>show that hormones used as add-on drugs </li></ul><ul><li>may have psychopharmacological effects in </li></ul><ul><li>different psychiatric entities </li></ul><ul><li>We present some clinical data from 15 years of work at the Institute of Biological Psychiatry (ipbi), Buenos Aires, Argentina </li></ul>
    • 5. <ul><li>Unipolar and bipolar TR depressive patients receiving thyroid hormone as add-on therapy </li></ul><ul><li>Females with menopausal depression receiving estrogen, progestins, tibolone, soy bean </li></ul><ul><li>Andropausic patients receiving DHEA </li></ul><ul><li>CFS patients receiving DHEA </li></ul>GROUP I GROUP II GROUP III GROUP IV
    • 6. I- Unipolar and bipolar TR depressives receiving thyroid hormone as an add-on therapy <ul><li>I a Treatment refractory unipolar depressive patient on add-on therapy with T3 </li></ul><ul><li>II b Treatment refractory “rapid cycling” bipolar depressive patients on add-on therapy with T4 </li></ul>
    • 7. Ia- Unipolar Treatment Refractory depressives receiving thyroid hormone as add-on therapy <ul><li>RATIONALE </li></ul><ul><li>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 </li></ul><ul><li>Low dose (5-50 mg/d) T3 &amp;quot;augmentation therapy&amp;quot; is the best documented treatment with thyroid hormones in depression </li></ul>
    • 8. Ia- Unipolar Treatment Refractory depressives receiving thyroid hormone as add-on therapy <ul><li>RATIONALE (cont) </li></ul><ul><li>STAR D The lower side effect burden and ease of use of T3 (50 µ gs) augmentation suggest that it has slight advantages over lithium (900mgs) augmentation for depressive patients who have had several failed medication </li></ul>
    • 9. Ia- Unipolar Treatment Refractory depressives receiving thyroid hormone as add-on therapy <ul><li>120 patients mostly female </li></ul><ul><li>TRD for at least 2 years </li></ul><ul><li>20% had blunted response to TRHST (trait marker for UD) </li></ul><ul><li>50-150 µ gs/d of triodothyronine was administered with ATD therapy </li></ul>
    • 10. Ia- Unipolar Treatment Refractory depressives receiving thyroid hormone as add-on therapy <ul><li>79% had a good response to new strategy within first three months </li></ul><ul><li>Measured by </li></ul><ul><ul><li>Clinical evaluation </li></ul></ul><ul><ul><li>Subjective impression </li></ul></ul><ul><ul><li>Beck or HAMD inventory </li></ul></ul><ul><li>Remission rates do not significately differenciate from control groups not receiving T3 </li></ul><ul><li>T3 is a good add-on therapy for TRD </li></ul>
    • 11. Unipolar Treatment Refractory depressives receiving thyroid hormone as add-on therapy response remission
    • 12. Ib- Treatment refractory “rapid cycling” bipolar depressive patients on add-on therapy with T4 <ul><li>RATIONALE </li></ul><ul><li>High-dose (250-500 micrograms/d) T4 is a well documented therapy for &amp;quot;rapid cycling bipolar disorder” refractory to lithium </li></ul>
    • 13. Ib- Treatment refractory “rapid cycling” bipolar depressive patients on add-on therapy with T4 <ul><li>34 patients (80% females) </li></ul><ul><li>Treatment refractory to various drugs (including lithium) </li></ul><ul><li>Medicated with lamotrigine, valproic acid and/or oxcarbamacepine </li></ul><ul><li>33% had hiperresponsiveness to TRH stimulus (state marker) </li></ul>
    • 14. Ib- Treatment refractory “rapid cycling” bipolar depressive patients on add-on therapy with T4 <ul><li>90% responded </li></ul><ul><li>Measured by </li></ul><ul><ul><li>Clinical evaluation </li></ul></ul><ul><ul><li>Subjective impression </li></ul></ul><ul><ul><li>Beck inventory or HAMD </li></ul></ul><ul><li>Improved remission rates </li></ul><ul><li>Cycle switch was less evident </li></ul>
    • 15. Ib- Treatment refractory “rapid cycling” bipolar depressive patients on add-on therapy with T4 response less switching in 5 years
    • 16. II- Females with menopausal depression receiving estrogen, progestin, tibolone, soy bean <ul><li>IIa - Females with menopausal depression receiving soy bean natural supplements </li></ul><ul><li>IIb - Females with menopausal depression receiving tibolone (STEARS) </li></ul><ul><li>IIc - Females with menopausal depression receiving combined HRT with different form of progestins </li></ul>
    • 17. II- Females with menopausal depression receiving estrogen, progestin, tibolone, soy bean <ul><li>RATIONALE </li></ul><ul><li>Ovarian steroids have widespread effects throughout the brain on serotonin pathways, catecholaminergic neurons, and the basal forebrain cholinergic system </li></ul><ul><li>Ovarian steroids have measurable effects on affective state as well as cognition </li></ul>
    • 18. Estrogens Progestins Estrogens/ Progestins SERMs STEARS Estrogens/ Androgens ARGENTINA TREATMENTS II- Females with menopausal depression receiving estrogen, progestin, tibolone, soy bean
    • 19. IIa- 50 patients receiving ATD therapy with or without soybean preparations 0 10 20 30 40 50 60 70 80 90 Percentage of improved patients ATD plus Soy bean derivates ATD alone Response (HAMD 6 weeks) No remission evaluated
    • 20. IIb- Female MDD receiving ATD therapy with (140) or without tibolone (77) Improvement 95% ATD plus tibolone ATD alone 80% Response (HAMD 6 weeks) No remission evaluated
    • 21. IIc- 120 patients receiving combined HRT with different forms of progesterone 56% 32% 0 10 20 30 40 50 60 70 Improvement in depression Response defined by HAMD and clinical evaluation RTH with Natural PG RHT with Medroxi-PG RTH with any progestins 0 10 20 30 40 50 60 70
    • 22. III- PADAM patients receiving DHEA supplements <ul><li>RATIONALE </li></ul><ul><li>DHEA is a precursor hormone which counteracts the aging and immuno-suppressive effects caused by corticosteroids </li></ul><ul><li>Supplementing DHEA has been shown to have anti-obesity effects, antiaging properties and stabilization of neurotrasmision </li></ul>
    • 23. III- PADAM patients receiving DHEA supplements <ul><li>Several studies adress the benefits of a long-term (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) </li></ul>RATIONALE (cont)
    • 24. III- PADAM patients receiving DHEA supplements <ul><li>44 patients </li></ul><ul><li>HAM D ≥ 15 </li></ul><ul><li>Receiving several ATD therapies </li></ul><ul><li>21 received ATD alone </li></ul><ul><li>23 received DHEA suplementation </li></ul>
    • 25. III PADAM patients receiving DHEA supplements Clinical Improvement 76% 48% DHEA No DHEA
    • 26. IV - CFS patients receiving DHEA <ul><li>RATIONALE </li></ul><ul><li>Chronic Fatigue Syndrome (CFS) is characterized by a persistent debilitating fatigue, muscle &amp; joint related symptoms and neuropsychiatric symptoms </li></ul><ul><li>Pathogenesis is associated with abnormalities of the endocrine system with impairment of the adrenal axis response </li></ul>
    • 27. IV- CFS patients receiving DHEA <ul><li>RATIONALE </li></ul><ul><li>Majority of patients with CFS have a serum cortisol and dehydroepiandrosterone sulfate (DHEA-S) deficiency which might be related to the neuropsychiatric symptoms </li></ul>
    • 28. IV- CFS patients receiving DHEA as add-on therapy <ul><li>200 patients receiving: </li></ul><ul><li>Pregabalin alone </li></ul><ul><li>Pregabalin plus duloxetine </li></ul><ul><li>Pregabalin plus duloxetine plus DHEA </li></ul>
    • 29. Duloxetine: 60 /120 mgs Pregabalin:150/450 mgs DHEA 100/200 mgs Clinical Improvement Ferran Scale CFS patients receiving DHEA as add-on therapy
    • 30. PSYCHOPHARMACOLOGICAL EFFECTS OF HORMONES DISCUSSION BEFORE CONCLUSIONS <ul><li>All patients received treatment on a clinical open basis </li></ul><ul><li>Patients were evaluated by different physicians over time </li></ul><ul><li>Hormonal replacement or add-on treatments may be off the label indications in some cases </li></ul><ul><li>Results must be reproduced in placebo-controlled studies </li></ul>
    • 31. PSYCHOPHARMACOLOGICAL EFFECTS OF HORMONES CONCLUSIONS <ul><li>Hormones or endocrine enhancers </li></ul><ul><li>can boost or augment </li></ul><ul><li>psychopharmalogical </li></ul><ul><li>action of drugs by direct action on the </li></ul><ul><li>receptors or as an add-on effect. </li></ul>
    • 32. THANK YOU <ul><li>ANDREA MARQUEZ LOPEZ MATO INSTITUTE OF BIOLOGICAL PSYCHIATRY </li></ul><ul><li>BUENOS AIRES. ARGENTINA </li></ul><ul><li>www.ipbi.com.ar </li></ul><ul><li>www.aapb.org.ar </li></ul>

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