Stress hormone-related psychopathology: pathophysiological and treatment implications.
Stress is commonly associated with a variety of psychiatric conditions, including major depression, and with chronic medical conditions, including diabetes and insulin resistance. Whether stress causes these conditions is uncertain, but plausible mechanisms exist by which such effects might occur. To the extent stress-induced hormonal alterations (e.g., chronically elevated cortisol levels and lowered dehydroepiandrosterone [DHEA] levels) contribute to psychiatric and medical disease states, manipulations that normalize these hormonal aberrations should prove therapeutic. In this review, we discuss mechanisms by which hormonal imbalance (discussed in the frameworks of "allostatic load" and "anabolic balance") might contribute to illness. We then review certain clinical manifestations of such hormonal imbalances and discuss pharmacological and behavioural treatment strategies aimed at normalizing hormonal output and lessening psychiatric and physical pathology.
Wolkowitz
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Department of Psychiatry, University of California, School of Medicine, San Francisco, USA. owenw@itsa.ucsf.edu
Epel
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Reus
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D000928:Antidepressive Agents / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000209:etiology; D003345:Corticosterone / Q000378:metabolism*; D003480:Cushing Syndrome / Q000453:epidemiology; D003687:Dehydroepiandrosterone / Q000378:metabolism*; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000378:metabolism / Q000523:psychology; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism; D018377:Neurotransmitter Agents / Q000378:metabolism; D010913:Pituitary-Adrenal System / Q000378:metabolism
D000928:Antidepressive Agents; D018377:Neurotransmitter Agents; D003687:Dehydroepiandrosterone; D003345:Corticosterone; D006854:Hydrocortisone