Geschlechtsunterschiede in Glucocorticoidkonzentrationen und Entzündungsparametern im Zusammenhang mit Depression

Zusammenfassung

Hintergrund: Frauen erkranken fast doppelt so häufig wie Männer an einer Major Depression. Eine Hyperaktivität der Hypothalamus-Hypophysen-Nebennierenrinden-Achse (HHNA) und eine chronisch niedrig-gradige Inflammation sind 2 der konsistentesten biologischen Befunde bei schweren Depressionen. Inwiefern diese Parameter für die Existenz von Geschlechtsunterschieden bei Depression eine Rolle spielen, ist noch unzureichend untersucht worden. Methoden: Es wurde eine systematische Literaturrecherche mittels der elektronischen Fachdatenbanken (PubMed, Web of Science, PsycARTICLES) durchgeführt. Die Suche umfasste alle englischsprachigen Artikel, die bis zum 29. Juni 2019 aufgenommen wurden. Als MeSH terms wurden depression, sex differences, inflammation, hpa axis, mit Zusätzen wie cortisol, crp, IL-6, TNF-alpha, dex/crh oder tsst verwendet. Ergebnisse: Insgesamt konnten 62 Primärstudien mit einem Total von 91318 Probanden (52 % Frauen) eingeschlossen werden. Basale Glucocorticoidkonzentrationen scheinen für beide Geschlechter tendenziell positiv mit dem Vorliegen oder der Schwere einer Depressionssymptomatik assoziiert zu sein. Konsistente Geschlechtsunterschiede konnten für die Cortisolreaktion auf einen Stressor sowie für Entzündungsmarker identifiziert werden. Fazit: Geschlechtsunterschiede in der Neurobiologie der Depression sind identifizierbar und geben Anlass für geschlechtsspezifische Untersuchungen der Pathophysiologie von Depressionen und deren geschlechtsspezifischer Behandlungen.

Abstract

Background: Women suffer from major depression almost twice as often as men. Hyperactivity of the hypothalamus-pituitary adrenal cortex axis (HHNA) and chronic low-grade inflammation are 2 of the most consistent biological findings in severe depression. The extent to which these parameters play a role in the existence of gender differences in depression has not yet been adequately investigated. Methods: A systematic literature search was performed using the electronic databases (PubMed, Web of Science, PsycARTICLES). The search included all English-language articles that were included until June 29, 2019. MeSH terms depression, sex differences, inflammation, hpa axis, with additives like cortisol, crp, IL-6, TNF-alpha, dex/crh or tsst were used. Results: A total of 62 primary studies met inclusion criteria encompassing 91318 individuals (52 % women). Basal glucocorticoid concentrations seem to be positively associated with the presence or severity of depression symptoms for both sexes. Consistent gender differences could be identified for the cortisol response to a stressor as well as for inflammatory markers. Conclusion: Sex differences in the neurobiology of depression are identifiable prompting future research investigating sex specific treatments.

Schlüsselwörter

Geschlechtsunterschiede - Depression - Cortisol - Inflammation

Key words

Sex differences - depression - cortisol - inflammation

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