| Objective:Depressive disorders are widely concerned with major symptoms such as depressed mood and diminished interest,and patients with depressive disorders are often accompanied by significant cognitive impairment,which affects their social function and prognosis.Escitalopram and paroxetine are commonly used antidepressants in clinical practice,and they can improve patients’cognitive function.In this study,the levels of hypothalamic-pituitary-gonadal axis(HPG)hormones and hypothalamic-pituitary-thyroid axis(HPT)hormones were measured before and after drug treatment in depressed patients,and the levels of depression and cognitive function were assessed before and after treatment.depression status and cognitive function levels before and after treatment,to analyze whether the improvement in cognitive function of patients is related to changes in HPG and HPT hormones,and thus to search for potential biomarkers of altered cognitive function in patients with depressive disorders.Method:One hundred and forty-eight patients with first-episode depression admitted to Shandong Mental Health Center between March 1,2021 to September 30,2022 were collected for the study.Randomly divided into two groups,group A received escitalopram drug treatment and group B received paroxetine drug treatment.Demographic general information(including gender,age,and education)and clinical general information(including duration of illness,first onset or not,age at first onset,and family history)were collected from all enrolled patients on the first day of admission using a self-administered clinical information questionnaire,and patients’depressive status was assessed using the Hamilton depression scale(HAMD)and cognitive function was assessed using the Montreal cognitive assessment scale(Mo CA).The following morning at 7:00 a.m.,thyroid hormone V and sex hormone VI were tested in the enrolled patients.After 8 weeks of treatment,the patients’depression status and cognitive function were assessed again,and thyroid hormone V and sex hormone VI were measured at 7:00 a.m.the next day.Results:1.After 8 weeks of drug treatment,the total HAMD scale score and five factors:anxiety/somatic,cognitive impairment,retardation,weight,and sleep disturbance scores decreased significantly in both groups(P<0.05);the total Mo CA scale score increased significantly in both groups(P<0.05),and among the seven factors,visuospatial and executive function,naming,attention,language,delayed recall,and orientation scores increased significantly in group A patients(P<0.05),and in group B patients(P<0.05).Among the seven factors,the scores of visuospatial and executive functions,naming,attention,language,delayed recall,and orientation were significantly higher in group A than before treatment(P<0.05),and in group B,the scores of visuospatial and executive functions,naming,language,orientation,delayed recall,and abstraction were significantly higher than before treatment(P<0.05).2.Comparison of the difference in HAMD scores before and after treatment:the difference in total score,cognitive impairment,latency,and sleep disturbance was greater in group A than in group B(all P<0.05).Comparison of the difference in Mo CA scores before and after treatment:the difference in total score,attention,and language was greater in group A than in group B,and the difference in delayed recall was less than in group B(all P<0.05).3.In group A,serum TT3,FT3,TT4,FT4,and LH concentrations were significantly decreased and TSH concentrations were significantly increased compared with those before treatment(all P<0.05);in group B,serum TT3,FT3,TT4,FT4,and PRL concentrations were significantly decreased compared with those before treatment(all P<0.05).4.The difference in serum FT4 concentrations before and after treatment was greater in group A than in group B.The difference in serum PRL concentrations before and after treatment was smaller in group A than in group B(all P<0.05).5.Factors associated with improved depressive status:differential cognitive impairment scores in Group A were found to be negatively correlated with differential serum T and positively correlated with differential serum PRL;weight differential score was positively correlated with differential serum TT3,FT3 and Prog(all P<0.05).group B HAMD total score differential score was negatively correlated with serum TSH concentration differential and positively correlated with serum FSH concentration differential.The difference score of cognitive impairment was negatively correlated with the difference of serum TSH concentration;the differential score for retardation was positively correlated with the differential serum LH and FSH;the difference score of weight was positively correlated with the difference of serum TT3 and TT4 concentration(all P<0.05).6.Correlates of improvement in cognitive function:group A Mo CA total score difference was negatively correlated with serum FT3,TT4,FT4 concentration difference;visuospatial and executive function difference score was negatively correlated with serum TT4,FT4concentration difference;attention difference score was negatively correlated with serum TT4,FT4 concentration difference;language difference score was negatively correlated with serum FT3,TT4,FT4concentration difference and with serum The difference score of Mo CA total score in group B was positively correlated with the difference of serum TSH and PRL concentrations;the difference score of naming difference was positively correlated with the difference of serum TT3 and FT3 concentrations.The language differential score was positively correlated with the difference in serum TT3 concentration;the abstract differential score was positively correlated with the difference in serum TT3 concentration(all P<0.05).7.Factors influencing improvement in cognitive function in the escitalopram treatment group:baseline FT4 concentration was an influencing factor for improvement in language factor score(β=-1.978,P<0.05),F=1.828,R~2=0.245;baseline Prog and PRL concentrations were influencing factors for improvement in attention factor score(β=-0.137,P<0.05;β=0.018,P<0.05),F=1.583,R~2=0.219.Conclusion:1.Both depressive status and cognitive function improved significantly after treatment with escitalopram and paroxetine medications,but the improvement was greater with escitalopram medication.2.After treatment with escitalopram,serum FT4 concentrations decreased significantly in patients,and to a greater extent than in patients treated with paroxetine.3.The improvement in depressive status of patients after treatment with escitalopram was associated with changes in serum T,PRL,TT3,FT3,and Prog concentrations.4.The improved changes in cognitive function in patients treated with escitalopram were associated with changes in serum TT3,FT3,TT4,FT4,and PRL concentrations.5.The lower the patient’s FT4 concentration,the more significant the improvement in language after escitalopram treatment,and the lower the Prog and PRL,the more significant the improvement in attention after escitalopram treatment. |
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