Effects of combination treatment with mood stabilizers and mirtazapine on plasma concentrations of neuroactive steroids in depressed patients
- 作者：Cornelius Schü ; le ; Thomas C. Baghai ; Flavia di Michele ; Daniela Eser ; Augusto Pasini ; Markus Schwarz ; Rainer Rupprecht ; Elena Romeo
- 关键词：Lithium ; Carbamazepine ; Mirtazapine ; Neuroactive steroids ; Neurosteroids ; Depressive disorder
- 刊名：Psychoneuroendocrinology
- 出版年：2007
- 期刊代码：228_03064530
- 类别：med
- 出版时间：July 2007
- 卷：32
- 期：6
- 页码：669-680
- 文件大小：841 K
摘要
Antidepressants such as SSRIs or mirtazapine have been demonstrated to increase the concentrations of 3α-reduced neuroactive steroids throughout several weeks of treatment. However, no data are available on the impact of mood stabilizers such as lithium or carbamazepine on neuroactive steroid levels in depressed patients. Study 1 was performed in 26 drug-free depressed inpatients who were treated with either mirtazapine monotherapy (n=13) or combination therapy with mirtazapine and addition of lithium (n=13). Twenty drug-free depressed inpatients were included in study 2, receiving either mirtazapine monotherapy (n=10) or combination treatment with mirtazapine and carbamazepine (n=10). Plasma samples were taken weekly at 0800 h in the morning and quantified for neuroactive steroids by means of combined gas chromatography/mass spectrometry analysis. In study 1, the mirtazapine-induced rises in 3α,5α-tetrahydroprogesterone and 3α,5β-tetrahydroprogesterone were abolished by additional lithium administration, as compared to mirtazapine monotherapy. In study 2, the mirtazapine-evoked increase in 3α,5α-tetrahydroprogesterone was reversed after additional administration of carbamazepine, presumably due to lowered mirtazapine levels after induction of cytochrome P450 enzymes. Apparently, the mood stabilizers lithium and carbamazepine do not enhance but rather reverse the increase in plasma concentrations of 3α-reduced neuroactive steroids in depressed patients pretreated with antidepressants such as mirtazapine.