Notes
<p>Aggression after TBI is common but not well defined. Hurting others.
• The prevalence of aggression was found to be 28.4% and to be predominantly
verbal aggression.
• Post-TBI aggression associated with:
– New-onset major depression
– Poorer social functioning
– Poorer function of activities of daily living
Aggression after Traumatic Brain Injury: Prevalence and Correlates. Rao, Vani., Et al. J Neuropsychiatry Clin
Neurosci. (2009) ; 21(4): 420–429. Division of Geriatric Psychiatry and Neuropsychiatry, Department of
Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD.</p>
<p><img src="/a5561c53-3622-4626-8183-404afb72a5ac.png" /></p>
<p>Major Depressive Disorder is Most Prevalent Post TBI • Growth Hormone Deficiency • Testosterone Deficiency is a Major Cause of Depression – Anxiety, aggression, Mood Disorder, Arousal, Sexual Dysfunction, Suicidal Ideation • Androgen Receptors are Present Throughout the Brain – Androgens have ongoing effects in mature brain – Androgens impact cognitive function.</p>
<p> </p>
<p> </p>
<p><img src="/5c512680-8509-4acd-af2b-50db288e8045.png" /></p>
<p><img src="/42e2ae8b-5cf8-4377-8a47-410aa485da0a.png" /></p>
<p>Testosterone and Depression Post TBI
Testosterone Effects the CNS
• Free testosterone in lowest quartile=highest incidence of depression
Male
– At Risk: 295 ng/dL Free T 6.0 ng/ml (Median 12-14 ng/ml)
– Depression: 147.5 ng/dL Free T 3.0 pg/ml
Female
– At Risk: 22 ng/dL (median 44 ng/dL) ; Free T 1.0 ng/dL (median 2-4 ng/dL)
– Depression: 11 ng/dL ; Free 0.5 ng/dL</p>
<p> </p>
<p>Case study: Olivia G.
Diagnosis: Treatment Resistant Depression</p>
<p style="padding-left: 150px;">
Olivia Median</p>
<p>
Total Testosterone 12.72 ng/ml 44 ng/ml</p>
<p>Free Testosterone 0.08 ng/ml 2-4 ng/ml</p>
<p>DHEA-S 49.2 ug/dL 235 ug/dL</p>
<p>DHT 4 ng/dL <30 ng/dL</p>
<p> </p>
<p><img src="/b943b587-634e-49df-aa0c-cbabcadaff3e.png" /></p>
<p><img src="/9dc74771-38bb-49a0-af36-dc338e465ab2.png" /></p>
<p>The Word on 5 Alpha Reductase is “Goldilocks”
DHT makes androgens (testosterone) more potent
Activity:
Metabolizes progesterone into a-Pregnanediol
Metabolizes cortisol into a-THF (b-metabolites of both through 5β activity)</p>
<p>
Upregulated leads to high androgen symptoms:
Men (thinning hair, prostate issues)
Women (PCOS, thinning hair, acne, facial hair growth)</p>
<p>
Increased enzyme activity:
High insulin and obesity
Edinger, KL; Frye, CA, Testosterone’s analgesic, anxiolytic and cognitive-enhancing effect may be due in part to
actions of its’ 5 alpha-reduced metabolites in the hippocampus; Behav Neuroscie; 2004 Dec;118(6):1352-64.
Albany, NY</p>
<p><img src="/a0461e94-3b0c-45d0-b1a2-adb803130100.png" /></p>
<p>Testosterone and DHT Elevation
• Finasteride and Dutasteride block conversion centrally</p>
<p>
– Cross BBB resulting in depression, fatigue, and sexual dysfunction
– Recommend Saw Palmetto, Pygeum, Pumpkin Seeds, Pomegranate Juice to
control conversion of T to DHT</p>
<p> </p>
<p>Testosterone Metabolizes into Estradiol
• S/S Estrogen Excess in Men
• Breast Enlargement
• Prostate Enlargement
• Difficulty Urinating
• Increased Emotional Lability
• Tearfulness</p>
<p> </p>
<p>Psychosis
(Thyroid Components)</p>
<p>Influences:
• Dopaminergic Myelination
• Serotonergic Inflammatory Processes
• Glutamatergic systems
• GABAergic
Thyroid acts a “fine-tuning mechanism” in functioning of neural networks</p>
<p>
Revisiting Thyroid Hormones in Schizophrenia. Journal of Thyroid Research Volume 2012, Article ID 569147. N. Santos,
et., at. Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Campus de Gualtar, Braga,
Portugal, Dept of Pathology, Leiden University Medical Center, Leiden, The Netherlands Institute of Medical Psychology, Faculty
of Medicine, U. of Coimbra, Coimbra, Portugal</p>