Hypothalamo-Pituitary-Adrenal Axis in Depressive Disorders and Treatment Resistance

Background: hypothalamo-pituitary-adrenal (HPA) axis plays an important role in the pathogenesis of depression. Patterns HPA functioning depend on both biologic factors and psychological background, which, taken together, may increase risk depression later on. Objective: to analyze scientific publications pathophysiology depression, linked disruption, assess causal relationship between hypercorticism clinical symptoms course depressive disorder. Material methods: according key words “hypercortiсism”, “depression disorder”, “cortisol”, “treatment resistant depression”, “Cushing’s syndrome”, “Сushing’s disease”, a search was conducted for databases Medline/ PubMed, Scopus, Web Science, RSCI other resources. Conclusion: there is high comorbidity disorders abnormalities, including endocrine with increased decreased cortisol secretion. Hypercorticism related Сushing’s disease or Cushing’s syndrome often associated irreversible mental disorders, especially anxiety which persist after normalization levels. Depressive patients are characterized by persistently elevated levels their non-supression 1 mg dexamethasone suppression test (DST); however, sometimes they have reduced The possible mechanisms discussed. Beside hypercorticism, level adrenocorticotropic hormone (ACTH) secretion ACTH CRH stimulation demonstrated. It has been demonstrated that elevation precede development as such can be used marker risk. promote its severity transform ation symptoms. Persistent DST predictors poor outcomes. dysfunction seems play essential evolvement treatment There data efficacy drugs modifying activity amelioration affective psychotic Further research into needed clarify pathogenetic newer approaches