Hypothalamic-Pituitary-Adrenal (HPA) axis hyperactivity measured with the dexamethasone suppression test
and the dexamethesone/CRH test may have some predictive power for suicidal behavior in patients with mood disorders.
Increased prolactin (PRL) levels may be related both to physiological and pathological conditions. HPA-axis
abnormalities and increased levels of PRL may coexist, and common neuroendocrine changes may activate both HPA axis
and PRL release. HPA-axis hyperactivity is presumably present in a large subpopulation of depressed subjects. Suicidal
behavior is considered to be a form of inward-directed aggression, and aggressive behavior has been connected to high
androgen levels. However, lower plasma total testosterone levels have also been reported in subjects with depression and
higher suicidality. Lipid/immune dysregulations, the increased ratio of blood fatty acids, and increased PRL levels may
each be associated with the increased production of pro-inflammatory cytokines, which have been reported in patients
with major depression and patients engaging in suicidal behavior. Although no studies have been done to determine
whether ante-mortem physical stress may be detected by raised post-mortem PRL, this would be of great interest for
Keywords: Suicidal behavior, stress, prolactin, HPA axis.
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