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Hormonersatztherapie und deren Wirkung auf Psyche und Gehirn

The effects of hormone replacement therapy on mind and brain

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Zusammenfassung

Während der Perimenopause führen hormonelle Schwankungen neben körperlichen Beschwerden auch zu einem gehäuften Auftreten psychischer Symptome wie Stimmungslabilität, depressiven Episoden, Panikattacken und Schlafstörungen. Gerade bei Depressionen und Angst ist die bedeutsame Rolle des Neurotransmitters Serotonin in der Krankheitsentstehung unbestritten, aber nur wenig ist über den Einfluss der Sexualhormone auf das Serotoninsystem bekannt. Dieser Beitrag soll eine Übersicht über die Risikofaktoren für eine depressive Erkrankung im menopausalen Übergang bieten und mögliche Therapieansätze diskutieren: Aktuelle Forschungsergebnisse aus longitudinalen Studien zur Wirksamkeit der Hormonersatztherapie und serotonerg wirkender Antidepressiva in der Behandlung von körperlichen und psychischen Beschwerden in der Perimenopause werden präsentiert. Darüber hinaus werden Studien vorgestellt, die mittels Positronenemissionstomographie und genetischer Methoden versuchen, Effekte der Sexualhormone auf einzelne Komponenten des Serotoninsystems zu erforschen. Die Wechselwirkungen zwischen Östrogen, Progesteron und dem serotonergen System werden beschrieben und die möglichen neurobiologischen und endokrinen Ursachen depressiver Symptome in der Perimenopause beleuchtet.

Summary

Hormonal fluctuations during the perimenopausal transition lead to physical discomfort but are also frequently accompanied by mood swings, depressive symptoms, anxiety and sleeping disorders. The important role of the neurotransmitter serotonin in the pathogenesis of anxiety disorders and major depression is unquestioned, but only little is known about the influence of sex hormones on the serotonergic system. This review provides an overview of potential risk factors for the occurrence of affective disorders in the menopausal transition and discusses possible therapeutic options. Current research findings from longitudinal studies testing the efficacy of hormone replacement therapy and antidepressants with effects on the serotonergic neurotransmission on physical and mental discomforts during menopause are presented. Furthermore, studies using positron emission tomography and genetic methods that explore the effects of sex steroids on different components of the serotonergic system are shown. The interactions between estrogen, progesterone and the serotonergic system are described, and possible neurobiological and endocrinological mechanisms underlying depressive symptoms in the perimenopause are elucidated.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin:

O. Univ.Prof. Dr.med. Dr.h.c.mult. Siegfried Kasper erhielt in den vergangenen 3 Jahren Forschungsförderungen und Beraterhonorare von folgenden Unternehmen: AstraZeneca, Bristol-Myers Squibb, CSC, Eli Lilly, GlaxoSmithKline, Janssen, Lundbeck, Merck Sharp and Dome (MSD), Novartis, Organon, Pierre Fabre, Pfizer, Schwabe, Sepracor, Servier und Wyeth. Ass.-Prof. PD Dr. R. Lanzenberger erhielt in den vergangen 3 Jahren Vortragshonorare und Reisekostenunterstützung von AstraZeneca und Lundbeck A/S. Dr. P. Baldinger, Dr. A. Höflich, Mag. G. Kranz, Dr. P. Stein und DI M. Savli geben an, dass kein Interessenkonflikt besteht.

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Authors and Affiliations

  1. Universitätsklinik für Psychiatrie und Psychotherapie, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090, Wien, Österreich

    P. Baldinger, G. Kranz, A. Höflich, M. Savli, P. Stein, R. Lanzenberger &  S. Kasper

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  1. P. Baldinger
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  2. G. Kranz
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  3. A. Höflich
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  4. M. Savli
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  5. P. Stein
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  6. R. Lanzenberger
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  7. S. Kasper
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Correspondence to S. Kasper.

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Baldinger, P., Kranz, G., Höflich, A. et al. Hormonersatztherapie und deren Wirkung auf Psyche und Gehirn. Nervenarzt 84, 14–19 (2013). https://doi.org/10.1007/s00115-011-3456-7

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  • DOI: https://doi.org/10.1007/s00115-011-3456-7

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