Clonidine hormonal

A number of non-hormonal therapies have been studied for symptomatic management of vasomotor symptoms, including antidepressants [e.g., selective serotonin reuptake inhibitors (SSRIs) and venlafaxine], herbal products (e.g., soy, black cohosh, and dong quai), and a group of miscellaneous agents (e.g., gabapentin, clonidine, and megestrol). The choice of therapy depends on the patient s concomitant disease states, such as depression and hypertension, and the risk for potential adverse effects. 

Overall, non-hormonal therapies are less effective in treating vasomotor symptoms than HRT but do offer an important option for women experiencing menopausal symptoms who cannot or are unwilling to take HRT. The antidepressants gabapentin and clonidine have the best evidence for efficacy of all the non-hormonal options and should be considered first as an alternative to HRT. The most important considerations in choosing an alternative therapy are the patient s comorbidities and the efficacy and safety of the medication. 

Growth hormone. Mood disorders have been related to alterations in the activity of the growth-hormone axis. A blunted growth-hormone response to clonidine, an a2 receptor agonist, has been consistently found in depression. Increased growth-hormone secretion during the day and decreased nocturnal growth-hormone secretion have also been observed in depressed patients. Depressed patients have lower CSF concentrations of somatostatin, compared to those with schizophrenia and normal controls. While lower CSF somatostatin is a state-dependent marker of depression, it occurs in a number of unrelated nonpsychiatric conditions, and thus appears to be relatively nonspecific. 

Siever, L. J., Trestman, R. L., Coccaro, E. F. et al. The growth hormone response to clonidine in acute and remitted depressed male patients. Neuropsychopharm. 6 165-177, 1992. 

Other Medications. A variety of other medications have been tried. These include hormone treatments and certain blood pressure medications (e.g., clonidine and the beta blockers). For the most part, these have met with minimal success and should not be considered a part of routine treatment. 

Increased density of 5-HT2a receptors on the platelet membrane Decreased uptake of 3H-5-HT into platelet Increased beta adrenoceptor density on lymphocyte membrane Increased density of alpha-2 adrenoceptors on platelet membranes ) Blrmted growth hormone response to a clonidine challenge Blrmted prolactin response to a fenfluramine challenge... 

Few studies have examined noradrenergic function in patients with phobic disorders. In patients with specific phobias, increases in subjective anxiety and increased heart rate, blood pressure, plasma NE, and epinephrine have been associated with exposure to the phobic stimulus (Nesse et al. 1985). This finding may be of interest from the standpoint of the model of conditioned fear, reviewed above, in which a potentiated release of NE occurs in response to a reexposure to the original stressful stimulus. Patients with social phobia have been found to have greater increases in plasma NE in comparison to healthy controls and patients with panic disorder (Stein et al. 1992). In contrast to panic disorder patients, the density of lymphocyte a-adrenoceptors is normal in social phobic patients (Stein et al. 1993). The growth hormone response to intravenous clonidine (a marker of central a2-receptor function) is blunted in social phobia patients (Tancer et al. 1990). 

Uhde TW, Tancer ME, Rubinow DR (1992) Evidence for hypothalamo-growth hormone dysfunction in panic disorder profile of growth hormone responses to clonidine, yohimbine, caffeine, glucose, GRF, and TRH in panic disorder patients vs. healthy volunteers. N europsychopharmacology 6 101-118... 

Coplan, J.D., Smith, E.L., Trost, R.C., Scharf, B.A., Altemus, M., Bjornson, L., et al. (2000) Growth hormone response to clonidine in adversely reared young adult primates relationship to serial cerebrospinal fluid corticotropin-releasing factor concentrations. Psychiatry Res 95 93-102. 

Effects of early environmental adversity on HPA mediation of neurodevelopment have also been demonstrated in non-human primates (Coplan et al., 1995). Corticotropin-releasing hormone (CRH) intracerebro-ventricular administration in rhesus monkeys that had been separated from their mothers produced behavioral inhibition and increases in ACTH and cortisol. Coplan et al (1995) presented evidence for persistently elevated cerebrospinal fluid concentrations of corticotropin-releasing factor (CRF) in grown macaques that had been reared by mothers in unpredictable environmental conditions. Further studies in adversely reared adult monkeys demonstrated an inverse relationship between mean CRF concentrations and GH response to clonidine (Coplan et al., 2000). In light of evidence that reduced GH response to clonidine has been shown in other anxiety disorders (Charney and Bremner, 1999), Coplan et al. (2000) hypothesize that GH response to clonidine may inversely reflect trait-like increases of central nervous system CRF activity. Data linking childhood anxiety to growth deficits are consistent with this view (Pine et al., 1996). Activity, of the HPA axis, as related to early environmental... 

Balldin, J., Berggren, U., Eriksson, E., Lindstedt, G., and Sundkler, A. (1993) Guanfacine as an alpha-2-agonist inducer of growth hormone secretion a comparison with clonidine. Psychoneuroendocrinology 18 45-55. 

Catalano M, Bellodi L, Lucca A, et al Lithium and alpha-2-adrenergic receptors effects of lithium ion on clonidine-induced growth hormone release. Neuroendocrinology Letters 6 61-66, 1984... 

Coplan JD, Papp LA, Martinez J, et al Persistence of blunted human growth hormone response to clonidine in panic disorder following fluoxetine treatment. Am J Psychiatry 152 619-622, 1995c... 

Clonidine stimulates the release of growth hormone and has been used as a provocation test of growth hormone reserve (290). 

Morris AH, Harrington MH, Churchill DL, Olshan JS. Growth hormone stimulation testing with oral clonidine 90 minutes is the preferred duration for the assessment of growth hormone reserve. J Pediatr Endocrinol Metab 2001 14(9) 1657-60. 

Blunted growth hormone response to a clonidine challenge... 

May be useful in decreasing the hypertension, tachycardia, and tremulousness associated with alcohol withdrawal, but not the seizures or delirium tremens In complicated alcohol withdrawal Clonidine may Improve social relationships, affectual responses, and sensory responses In autistic disorder Clonidine may reduce the Incidence of menopausal flushing Growth hormone response to clonidine may be reduced during menses Clonidine stimulates growth hormone secretion (no chronic effects have been observed)... 

Alcohol may reduce the effects of clonidine on growth hormone... 

Gid-Ad I, Topper E, Laron Z. Oral clonidine as a growth hormone stimulation test. Lancet 1979 2 278-80. 

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