مقالات پذیرفته شده در نهمین کنگره بین المللی زیست پزشکی
Comparative Effectiveness of Pharmacological versus Psychotherapeutic Interventions for Depression in Patients with Endocrine Disorders: A Review
Comparative Effectiveness of Pharmacological versus Psychotherapeutic Interventions for Depression in Patients with Endocrine Disorders: A Review
Melina Hashem Aghaee,1Sanaz Soleimani,2,*Ehsan Safaee,3Kiarash Mohebbipour,4Amirreza Lak,5
1. Student Research Committee, School of medicine,Iran University of Medical science, Tehran, Iran 2. Student Research Committee, School of medicine,Iran University of Medical science, Tehran, Iran 3. Student Research Committee, School of medicine, Shahed University, Tehran, Iran 4. Student Research Committee, School of medicine,Iran University of Medical science, Tehran, Iran 5. Student Research Committee, School of medicine,Iran University of Medical science, Tehran, Iran
Introduction: The bidirectional association between endocrine disorders and depression offer unique therapeutic challenges, with higher rates of depression found in patients of diabetes mellitus, thyroid disorders, polycystic ovary syndrome, and adrenal disorders. The intricate relationship between issues in hormonal regulation and mood disorders calls for treatment with care, since usual treatments might have to be altered when dealing with underlying endocrinopathies.
This narrative review compares the side effects and efficacy of pharmacological interventions, psychotherapeutic approaches, and combined treatments in managing depression among patients with endocrine disorders.
Methods: In this study, we collected data from English and Persian databases (PubMed, Scopus, WOS, SID, and Civilica), with the following MeSH terms: "depression", "endocrine disorders", "diabetes mellitus", "thyroid disorders", "adrenal disorders", "Addison's disease", "Cushing's syndrome", "PCOS", "antidepressants", "psychotherapy", "cognitive behavioral therapy", and "pharmacological treatment" from 2014 to 2024. Studies were screened and 21 articles were included based on the PRISMA protocol.
Results: Presently, available evidence indicates treatment responses that vary across endocrine diseases. With regard to diabetes mellitus, studies of cognitive behavioral therapy approaches promise treatment against depressive symptoms and diabetes-related distress. Several randomized controlled trials have tested CBT interventions in diabetic patients with depression; these trials have included treatment adherence and glycemic control along with mood symptoms as outcomes. These studies seem to indicate that psychological intervention may have a beneficial effect on the complex relationship between diabetes management and mental health.
The landscape of therapeutic interventions for thyroid disorders is rather complex. Research shows that the main treatment of depression in hypothyroidism is thyroxine substitution therapy, and the question in actuality thus remains-whether antidepressants should be given adjunctively during patient treatment. Studies relating to the treatment of depression secondary to subclinical thyroid dysfunction give contrasting views on its treatment strategies. Meta-analytical data show the interaction between thyroid function and mood symptoms, but there are controversies about the best method for treatment.
Adrenal disorders have unique challenges to depression management. A recent population-based cohort study suggests that patients with autoimmune Addison's disease are significantly more likely to use psychotropic medications, mainly hypnotics/sedatives, anxiolytics, and antidepressants, in the year preceding diagnosis. This implies that early symptoms of adrenal insufficiency are considered primary psychiatric disorders and hence get treated principally with psychotropic medications instead of the underlying endocrine pathology. Case reports of Cushing's syndrome suggest that endocrine causes should be considered where depression is the presenting symptom, as the delay in diagnosis could alter treatment efficacy.
The study of depression linked with PCOS has become an important area of research, investigating pharmacological and psychological methods of intervention. Systematic reviews have considered the efficacy of cognitive behavioral therapy implemented specifically for women with PCOS, given that psychological distress in this population is multidimensional and includes concerns about fertility, body image, and metabolic health.
Conclusion: For depression in endocrine disorders, the evidence supporting pharmaceutical vs psychotherapy interventions is always shifting. Regardless, treatment modalities could likely show effectiveness differently with respect to specific endocrine disorders, patient characteristics, and treatment goals. Future investigations should thus concern themselves with the creation of standardized protocols for an integrated approach to endocrine and psychiatric care, focusing primarily on long-term outcomes and patient-centered measures. Treatment algorithms developed for various endocrine disorders might facilitate and promote clinical decision-making and patient outcomes.