Neurosteroid levels in patients with obsessive compulsive disorder

INTRODUCTION: Sex hormones may be responsible for the differencesbetween genders with obsessive compulsive disorder (OCD). Limited numbersof studies evaluating sex hormones in patients with OCD exist in theliterature. Inour study we aimed to evaluate the plasma levels of neurosteroids in OCDpatients and to also determine their possible relationships with thepathophysiological mechanisms of the illness.METHODS: 30 patients diagnosed as OCD accordingto DSM-IV-TR diagnosticcriteria and 30 healthy volunteers were included in the study. Blood sampleswere collected from patients and control subjects at 9-10 o?clock a.m in themorning for determining the plasma levels of progesterone, pregnanolone,dehydroepiandrosterone (DHEA), dehydroepiandrosterone-sulphate (DHEA-S),cortisol and testosterone. The Hamilton anxiety scale, Hamilton depressionscale and yale-brown obsessive compulsive scale were applied to allpatients.Datas were analyzed using appropriate statistical methods.FİNDİNGS: Plasma levels of DHEA and cortisol have been found higher inpatients compared to those in control subjects. No statistically significantdifference was found in other parameteres. Plasma levels of DHEA and cortisolin female patients were significantly higher than female control subjects, whilemale patients having significantly higher levels of cortisol and lower levels oftestosterone than male control subjects. Furthermore, a positive correlation wasfound between the cortisol levels and scores of compulsion in male patients.Patients who had no additional diagnosis of depression and impulse controldisorder, had significantly higher levels of DHEA and cortisol than control58subjects in the detailed analyzes. The patients having additional diagnosis withdepression and impulse control disorder, were observed to have duration ofillness under 15 years.DİSCUSSİON: Higher levels of DHEA and cortisol in OCD patients areconsistent with the results of studies regarding anxiety disorders. This findingmay be resulting from hyperactivity of hypothalamic-pituitary-adrenal axis whichis evidenced to play role in anxiety disorders. As an other point of view, it canbe conceivable the high plasma levels of DHEA compansate for increasinglevels of cortisol and stress. Although this elevation of DHEA levels has notbeen found statistically significant in malepatients, it has been found significantin female patients. The reason might be the hypoactivity of hypothalamicpituitary-gonadal axis in males with OCD. The presence of low plasma levels oftestosterone in males, significantly confirms this suggestion. It can beconcluded that increasing plasma levels of DHEA compansate for the states ofimpulse control disorder and depression. As a result, further clinical studiesincluding large numbers of subjects and regarding the sex in these patientsrespectively, are needed to confirm these conclusions.