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Lookup NU author(s): Dr Richard Porter,
Dr Peter Gallagher
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Background: New evidence is emerging regarding abnormalities of hypothalamic-pituitary-adrenal (HPA) axis function in subtypes of affective disorders. Adverse effects of HPA axis dysregulation may include dysfunction of monoaminergic transmitter systems, cognitive impairment and peripheral effects. Newer treatments specifically targeting the HPA axis are being developed. Objective: To review these developments focusing particularly on the glucocorticoid receptor (GR) antagonist mifepristone. Method: A selective review of the literature. Results: The function of GRs is increasingly being defined. The role of corticotrophin-releasing hormone (CRH) and dehydroepiandrosterone (DHEA) in the brain is also increasingly understood. HPA axis function is particularly likely to be abnormal in psychotic depression and bipolar disorder, and it is in these conditions that trials of the GR antagonist mifepristone are being focused. CRH antagonists and DHEA are also being investigated as potential treatments. Conclusion: Initial studies of mifepristone and other HPA-axis-targeting agents in psychotic depression and bipolar disorder are encouraging and confirmatory studies are awaited. © 2006 Blackwell Munksgaard.
Author(s): Porter RJ, Gallagher P
Publication type: Review
Publication status: Published
Journal: Acta Neuropsychiatrica
Print publication date: 01/10/2006
ISSN (print): 0924-2708
ISSN (electronic): 1601-5215