Targeting hypothalamic-pituitary-adrenal axis hormones and sex steroids for improving cognition in major mood disorders and schizophrenia: a systematic review and narrative synthesis

• Published in: Psychoneuroendocrinology 2018-07, Vol.93, p.8-19
• Main Authors: Soria, Virginia, González-Rodríguez, Alexandre, Huerta-Ramos, Elena, Usall, Judith, Cobo, Jesús, Bioque, Miquel, Barbero, Juan David, García-Rizo, Clemente, Tost, Meritxell, Monreal, José Antonio, Labad, Javier
• Format: Article
• Language: English
• Subjects: Affective Disorders, Psychotic - metabolism; Affective Disorders, Psychotic - physiopathology; Bipolar disorder; Bipolar Disorder - physiopathology; Cognition; Cognition Disorders - physiopathology; Cognitive Dysfunction - physiopathology; Cortisol; Depression; Depressive Disorder, Major - physiopathology; Female; Gonadal Steroid Hormones - therapeutic use; Humans; Hydrocortisone; Hypothalamo-Hypophyseal System - physiopathology; Male; Mifepristone - therapeutic use; Mood Disorders - physiopathology; Pituitary-Adrenal System - physiopathology; Pregnenolone - therapeutic use; Raloxifene Hydrochloride - therapeutic use; Schizophrenia; Schizophrenia - metabolism; Schizophrenia - physiopathology; Sex steroids
• ISSN: 0306-4530; 1873-3360
• DOI: 10.1016/j.psyneuen.2018.04.012

•We reviewed the use of hormones for enhancing cognition in serious mental illnesses.•Hypothalamic-pituitary-adrenal axis hormones and sex steroids were considered.•Mifepristone might enhance cognition in patients with bipolar disorder.•Raloxifene and pregnenolone have pro-cognitive effects in patients with schizophrenia. Cognitive deficits are a core feature of serious mental illnesses such as schizophrenia, major depressive disorder (MDD) and bipolar disorder (BD) and are a common cause of functional disability. There is limited efficacy of pharmacological interventions for improving the cognitive deficits in these disorders. As pro-cognitive pharmacological treatments are lacking, hormones or drugs that target the endocrine system may become potential candidates for ‘repurposing’ trials aiming to improve cognition. We aimed to study whether treatment with drugs targeting the hypothalamic-pituitary-adrenal (HPA) axis and sex steroids can improve cognition in patients with schizophrenia, MDD or BD. A systematic search was performed using PubMed (Medline), PsychInfo and clinicaltrials.gov, and a narrative synthesis was included. The systematic review identified 12 studies dealing with HPA-related drugs (mifepristone [n = 3], cortisol synthesis inhibitors [ketoconazole, n = 2], dehydroepiandrosterone [n = 5], fludrocortisone [n = 2]) and 14 studies dealing with sex steroids (oestradiol [n = 2], selective oestrogen receptor modulators [raloxifene, n = 7], pregnenolone [n = 5]). Positive trials were found for BD (mifepristone), MDD (dehydroepiandrosterone and fludrocortisone) and schizophrenia (dehydroepiandrosterone, raloxifene and pregnenolone). A replication of positive findings by at least two clinical trials was found for mifepristone in BD and raloxifene and pregnenolone in schizophrenia. The use of drugs targeting hormones related to the HPA axis and sex steroids is a promising field of research that might help to improve the cognitive outcome of patients with schizophrenia, bipolar disorder and major depressive disorder in the near future.