The silver violin string.

A growing body of literature describes the effects of estrogen and other gonadal steroids on the central nervous system. The ability of estrogen to modulate serotonergic function, in particular, raises the possibility that sex steroids may play a role in the mechanisms associated with depression and its treatment. This review will focus on those aspects of the estrogen-serotonin interaction that relate to possible increased vulnerability to affective disorders and on hormonal treatments that may be clinically applicable to women. After a discussion of the potential relationship between estrogen and mood disorders across the female life cycle, a model is proposed in which differential sensitivity to mood disorders explains the differential response by some women to periods of normal hormonal changes. Possible serotonin receptor-mediated and intracellular mechanisms by which estrogen may exert its effects on mood are also reviewed. These are compared to putative mechanisms of standard antidepressant effect. Lastly, treatment studies in which estrogen has been used as 1) monotherapy for depression, 2) an augmentation strategy, or 3) a prophylactic intervention against recurrence of depression are reviewed.

Antidepressive Agents↗

PubMed1998

[Risk factors associated with the consumption of antidepressant agents].

OBJECTIVES: To find the profile of the consumer of anti-depressants, identify risk factors and calculate the prevalence of the under-diagnosis of depression in our milieu. DESIGN: Case-control study. SETTING: Gavà II Health Centre, Barcelona. PARTICIPANTS AND METHODS: The study covered 134 consumers of anti-depressants and 274 controls with no treatment (one group from the Centre, the other from the community) paired for sex, age and general practitioner. The Zung-Conde self-applied depression) scale was administered. MEASUREMENTS AND MAIN RESULTS: 88% of those surveyed were women, with an average age of 50. The prescribing doctor was, in 55% of cases, their general practitioner. The anti-depressants prescribed were mainly (70.9%) from the group of selective inhibitors of serotonin uptake. There were more divorced and widowed people among the cases (p < 0.05). The pathology most often associated with the cases was digestive (31%, p < 0.02). 63% of cases had suffered some event they thought important in the 6 months before prescription. Average score on the Zung test was 51.5% in the cases, and 40% in the controls (p < 0.0001). Using 50 on the Zung scale as the cut-off point, we classified 56% of the cases and 17% of the controls as depressed. CONCLUSIONS: The profile of the consumer of anti-depressants is a women of about 50, living as one of a couple, house-wife, with primary education only, and medium to low social and economic level. The prevalence in the controls of depressive illness neither detected nor treated is similar to that found in other studies. We need to find some instrument to measure attitude, in order to reduce the number of patients who are underdiagnosed in the consulting room.

Antidepressive Agents↗