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Tijdschrift voor Psychiatrie 44 (2002) 3, 183 - 192

Essay

Anxiety/aggression-driven depression

H.M. van Praag

summary A new subtype of depression is hypothesized, named anxiety/aggression-driven depression. Psychopathologically it is characterized by increased anxiety and aggression being precursor symptoms as well as pacemaker symptoms: symptoms capable of inducing, secondarily, disturbances in mood regulation. If they do so, the syndrome of a full-blown depression will develop. Biologically this depression type is characterized by 5HT-disturbances, in which the 5HT1A-receptor subsystem seems to be involved. The 5HT-ergic disturbances are hypothesized to be determined or amplified by hypercortisolemia. Goal-directed treatment of this depression type is hypothesized to consist of a full, selective, postsynaptically acting 5HT1A-agonist, in combination with a cortisol or corticotropin-releasing hormone antagonist and also psychological interventions geared towards reinforcing coping strategies. Prophylaxis will require the same approaches. The compounds mentioned are in advanced development, and thus these hypotheses can soon be put to the test.

keywords anxiety/aggression-driven depression, corticotropin-releasing hormone antagonist, cortisol antagonist, hypothalamic-pituitary-adrenal axis, 5ht1A-receptor agonist, serotonin