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      Interacción estrógenos-noradrenalina en la depresión Translated title: Estrogens-noradrenaline interactions: their role in the regulation of depression

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          Abstract

          La depresión se define como un trastorno del estado de ánimo caracterizado por un estado de tristeza profunda y una pérdida de interés o placer. Este trastorno psiquiátrico afecta al 12% de la población mundial, siendo las mujeres quienes más la padecen. La depresión es una patología compleja, en la que se ha observado que el sistema noradrenérgico cumple un papel importante. Así, una disminución en el tono noradrenérgico, los cambios en la síntesis y el metabolismo de la noradrenalina (NA), así como en la modulación de sus receptores, pueden conducir a un estado depresivo. Por otro lado, los estrógenos son un grupo de hormonas gonadales con diversas funciones fisiológicas, incluidas las que se relacionan con los estados afectivos. Diversos estudios clínicos sugieren que las fluctuaciones hormonales, como la etapa premenstrual, el puerperio y la perimenopausia, se asocian con un aumento en la vulnerabilidad a presentar depresión y se ha demostrado que los estrógenos presentan efectos antidepresivos en diversos modelos conductuales. En estudios electrofisiológicos y de unión de ligando se reporta que los estrógenos son capaces de modular la transmisión noradrenérgica a través de diferentes mecanismos, los cuales incluyen un aumento en la frecuencia de disparo de las neuronas noradrenérgicas, la regulación de la densidad de los receptores noradrenérgicos, así como en los procesos de síntesis y metabolismo de este neurotransmisor. Además, diversos estudios conductuales han aportado información que apoya la participación de los estrógenos en la modulación del sistema noradrenérgico e incluso se ha propuesto que a través de esta vía podrían inducir sus efectos antidepresivos. De esta forma, el propósito de esta revisión es analizar, a nivel clínico y preclínico, la participación de la noradrenalina y de los estrógenos, y la relación entre ambos en el tratamiento de la depresión.

          Translated abstract

          Depression refers to a mood disorder characterized by deep sadness and loss of interest and pleasure. Epidemiologic studies show that this disorder represents a public health problem affecting 12% of the world population in a proportion of 2:1 of women to men. Depression is a complex disease in which it has been observed that the noradrenergic system appears to play an important role. Thus, a decrease in the noradrenergic tone, changes in noradrenaline (NA) synthesis, reduction in its turn-over, and modulation of its receptors can induce this disease. On the other hand, estrogens are a wide hormones family with multiple biologic functions which include those related to mood states. Clinical studies suggest that hormonal fluctuations, such as the premenstrual phase, puerperium and perimenopause, are associated with an increase in the vulnerability to depression. Conversely, estrogens have shown antidepressant effects in different preclinical models. Binding and electrophysiology studies suggest that estrogens are able to modulate noradrenergic transmission, through an increase of NA neurons' firing rate, a regulation of noradrenergic receptors and the synthesis and catabolism of this neurotransmitter. Additionally, behavioral studies support the interaction of estrogens with the noradrenergic system. Thus, the purpose of this review is to analyze the participation of noradrenalin, estrogens and their interaction in the treatment of depression in both, clinical and preclinical studies.

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          The epidemiology of major depressive episodes: results from the International Consortium of Psychiatric Epidemiology (ICPE) surveys

          Absence of a common diagnostic interview has hampered cross‐national syntheses of epidemiological evidence on major depressive episodes (MDE). Community epidemiological surveys using the World Health Organization Composite International Diagnostic Interview administered face‐to‐face were carried out in 10 countries in North America (Canada and the US), Latin America (Brazil, Chile, and Mexico), Europe (Czech Republic, Germany, the Netherlands, and Turkey), and Asia (Japan). The total sample size was more than 37,000. Lifetime prevalence estimates of hierarchy‐free DSM‐III‐R/DSM‐IV MDE varied widely, from 3% in Japan to 16.9% in the US, with the majority in the range of 8% to 12%. The 12‐month/lifetime prevalence ratio was in the range 40% to 55%, the 30‐day/12‐month prevalence ratio in the range 45% to 65%, and median age of onset in the range 20 to 25 in most countries. Consistent socio‐demographic correlates included being female and unmarried. Respondents in recent cohorts reported higher lifetime prevalence, but lower persistence than those in earlier cohorts. Major depressive episodes were found to be strongly co‐morbid with, and temporally secondary to, anxiety disorders in all countries, with primary panic and generalized anxiety disorders the most powerful predictors of the first onset of secondary MDE. Major depressive episodes are a commonly occurring disorder that usually has a chronic‐intermittent course. Effectiveness trials are needed to evaluate the impact of early detection and treatment on the course of MDE as well as to evaluate whether timely treatment of primary anxiety disorders would reduce the subsequent onset, persistence, and severity of secondary MDE. Copyright © 2003 Whurr Publishers Ltd.
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            International Union of Pharmacology nomenclature of adrenoceptors.

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              Efficacy of estradiol for the treatment of depressive disorders in perimenopausal women: a double-blind, randomized, placebo-controlled trial.

              Results of previous studies suggest that estrogen improves somatic and mild depressive symptoms experienced by perimenopausal women. This study investigated the efficacy of 17beta-estradiol for the treatment of clinically significant depressive disorders in endocrinologically confirmed perimenopausal women. Perimenopausal women (aged 40-55 years, with irregular menstrual periods and serum concentrations of follicle-stimulating hormone >25 IU/L), meeting criteria for major depressive disorder, dysthymic disorder, or minor depressive disorder, according to DSM-IV, were randomized to receive transdermal patches of 17beta-estradiol (100 microgram) or placebo in a 12-week, double-blind, placebo-controlled study. A 4-week washout period followed the 12-week treatment phase. Outcome measures were the Montgomery-Asberg Depression Rating Scale and Blatt-Kupperman Menopausal Index scores. Fifty women were enrolled in the study; 26 met DSM-IV criteria for major depressive disorder, 11 for dysthymic disorder, and 13 for minor depressive disorder. Remission of depression was observed in 17 (68%) women treated with 17beta-estradiol compared with 5 (20%) in the placebo group (P =.001). Subjects responded similarly to estradiol treatment, regardless of DSM-IV diagnosis. Patients treated with estradiol sustained antidepressant benefit of treatment after the 4-week washout period, although somatic complaints increased in frequency and intensity. Treatment was well tolerated and adverse events were rare in both groups. Transdermal estradiol replacement is an effective treatment of depression for perimenopausal women.
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                Author and article information

                Journal
                sm
                Salud mental
                Salud Ment
                Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (México, DF, Mexico )
                0185-3325
                August 2013
                : 36
                : 4
                : 331-336
                Affiliations
                [01] Tlalpan DF orgnameInstituto Nacional de Psiquiatría Ramón de la Fuente Muñiz orgdiv1Dirección de Neurociencias orgdiv2Laboratorio de Neuropsicofarmacología México estrada@ 123456imp.edu.mx
                [03] orgnameInstituto Politécnico Nacional orgdiv1Escuela Superior de Medicina orgdiv2Sección de Posgrado e Investigación
                [02] orgnameCentro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional orgdiv1Departamento de Farmacobiología
                Article
                S0185-33252013000400008 S0185-3325(13)03600400008
                a27ec956-9472-4172-a4dc-f1126bfce164

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 08 August 2012
                : 19 April 2013
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 61, Pages: 6
                Product

                SciELO Mexico

                Categories
                Actualización por temas

                adrenaline,adrenalina,Estrogens,Estrógenos,depression,depresión

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