Classic hypothalamic-pituitary-end-organ feedback loops – the hypothalamic-pituitary-adrenal axis (HPAA), hypothalamic-pituitary-thyroidal axis (HPTA), and hypothalamic-pituitary-gonadal axis (HPGA) – are associated with the neuroendocrine and immune systems in major depressive disorder (MDD). Female patients with MDD present with evident neuroendocrine and immunological changes. Glucocorticoid, thyroid hormone, and reproductive steroid levels fluctuate with menstrual cycles, which might lead to glucocorticoid receptor resistance, impairment of triiodothyronine conversion, and sex hormone secretion disorders. In this review, we summarize the independent and interactive functions of these three axes in female MDD patients. The similar molecular structure of steroids implies an interrelationship between the hypothalamic-pituitary-end-organ axes and the competitive inhibitory effects at the receptor level, especially when considering the HPAA and HPGA.

Objective:To investigate the clinical characteristics of bipolar disorder patients who present with depressive symptoms at their first episode.Methods:A total of 1 600 bipolar disorder patients with the first episode of depression who participated in the clinical pathway survey of bipolar disorder were included in this study. Demographic data, clinical phenotype, and symptomatic characteristics when they presented with their first mania were described. One-way analysis of variance was applied to compare the clinical characteristics between patients who visited the general hospitals and the ones who visited the mental health centers, and chi-square test was applied to compare symptomatology of patients at the first hypomania/mania episode and their mania relapse.Results:The average time from the first depressive episode to the first hypomanic/manic episode was 3.63 years. It took an average of 1.83 years from the first hypomanic/manic episode to the diagnosis of bipolar mania, and only 45.4% (728 cases) were diagnosed as bipolar disorder when they presented with depression at their first episode; It was an average of 5.45 years from the first depressive episode to the diagnosis of bipolar disorder; There were statistically significant differences in the number of previous depressive episodes ( F=7.119, P=0.008) and the total number of previous episodes ( F=3.980, P=0.046) between bipolar disorder patients seen in the mental health centres and general hospitals. The top three symptoms of the first manic episode were mood elation (83%, 215 cases); increased activity (81.5%, 211 cases); increased speech (79.9%, 207 cases). Compared with recurrent manic episodes, patients at their first manic episode were more likely to report more gregarious (χ2=13.277, P<0.01), eloquent/humorous (χ2=10.665, P=0.001), and less likely to report excessive use of psychoactive substances (χ2=3.990, P=0.046). Conclusions:It takes a long time for the diagnosis of bipolar disorder who presents with the depressive mood in their first episode. The first manic episode is not easy to identify, and the patients treated in general hospitals have more frequent depressive episodes, while the first manic episode shows some different symptoms from the recurrent manic episodes.

Objective:To investigate the clinical characteristics of bipolar disorder patients who present with depressive symptoms at their first episode.Methods:A total of 1 600 bipolar disorder patients with the first episode of depression who participated in the clinical pathway survey of bipolar disorder were included in this study. Demographic data, clinical phenotype, and symptomatic characteristics when they presented with their first mania were described. One-way analysis of variance was applied to compare the clinical characteristics between patients who visited the general hospitals and the ones who visited the mental health centers, and chi-square test was applied to compare symptomatology of patients at the first hypomania/mania episode and their mania relapse.Results:The average time from the first depressive episode to the first hypomanic/manic episode was 3.63 years. It took an average of 1.83 years from the first hypomanic/manic episode to the diagnosis of bipolar mania, and only 45.4% (728 cases) were diagnosed as bipolar disorder when they presented with depression at their first episode; It was an average of 5.45 years from the first depressive episode to the diagnosis of bipolar disorder; There were statistically significant differences in the number of previous depressive episodes ( F=7.119, P=0.008) and the total number of previous episodes ( F=3.980, P=0.046) between bipolar disorder patients seen in the mental health centres and general hospitals. The top three symptoms of the first manic episode were mood elation (83%, 215 cases); increased activity (81.5%, 211 cases); increased speech (79.9%, 207 cases). Compared with recurrent manic episodes, patients at their first manic episode were more likely to report more gregarious (χ2=13.277, P<0.01), eloquent/humorous (χ2=10.665, P=0.001), and less likely to report excessive use of psychoactive substances (χ2=3.990, P=0.046). Conclusions:It takes a long time for the diagnosis of bipolar disorder who presents with the depressive mood in their first episode. The first manic episode is not easy to identify, and the patients treated in general hospitals have more frequent depressive episodes, while the first manic episode shows some different symptoms from the recurrent manic episodes.

Objective·To compare the clinical features between different subtype bipolar patients with first mania episode, and to contribute to early identification of bipolar disorder. Methods·This study was based on the database named as National Bipolar Mania Pathway Survey (BIPAS). From November 2012 to January 2013, bipolar patients from 26 mental health facilities in China were enrolled in current study. The clinical features were compared between mania patients of different subtypes, including hypomania (groupⅠ), mania without psychotic symptoms (groupⅡ), mania with psychotic symptoms (group Ⅲ) and mixed state (group Ⅳ). Results·There was significant difference in the percentage of clinical symptoms between different subtype bipolar patients with first mania episode, especially the mania and anxiety related symptoms. Group Ⅰ, Ⅲ , Ⅳ were further compared with groupⅡ, which was considered as the typical bipolar disorder. The results showed that the mania related symptoms was significantly higher in group Ⅱ, but anxiety related symptoms was significantly higher in group Ⅰ, Ⅲ, Ⅳ. Moreover, Logistic regression analysis revealed that more eloquent or humor and unusually restless could be in favor of the diagnosis of hypomania; younger and mania or hypomania as first episode might be in favor of the diagnosis of mania with psychotic symptoms; older, national minorities and unusually restless could be in favor of the diagnosis of mixed state. Conclusion·The clinical features between different subtype bipolar patients with first mania episode are various, and analysis of the clinical features can contribute to early identification of bipolar disorder.