Avaliação de fatores biopsicossociais associados ao diagnóstico e tratamento do transtorno depressivo maior: a influência dos papéis sexuais e das neurotrofinas no diagnóstico e tratamento

Abstract

Introduction: Research has shown that depressive episodes are influenced by biological, psychosocial and socio-cultural aspects, that can determine the symptoms, course and treatment of depressive disorder. Among the biological aspects, are the neurotrophins, which can be considered as potential biomarkers for depression. Between psychosocial and socio-cultural aspects, are the sexual roles as cognitive structure of subject identity constructs for you. Objective: This thesis aims to develop the evaluation of Biopsychosocial Factors associated with the diagnosis and treatment of major depressive disorder (MDD), from the research on the influence of sexual roles and of neurotrophins in the diagnosis and treatment of this disorder. Methods: Two studies with patients between 18 and 65 years old, diagnosed with major depressive disorder by current Mini International Neuropsychiatric Interview (M.I.N.I.) Plus and met in the outpatient and research in Mental Health in the city of Pelotas, RS. The first study was developed by cross-sectional method, selecting as participants all patients diagnosed with TDM and who fulfilled the eligibility criteria for the randomized clinical trial, regardless of the model of psychotherapeutic treatment to which they were randomized (Psychodynamic or cognitive-behavioral therapy). In this study, we used as verification of depressive symptoms by the Beck Depression Inventory (BDI)-II, and the observation of sexual roles through the Right Sex Role Inventory (BSRI), both performed in the first date of treatment. The second study was developed by the quasi-experimental method, nested randomized clinical trial to evaluate the efficacy of two models of psychotherapy for Depression, considering only those patients randomized to the follow-up in therapy Cognitive-Behavioral (CBT). In this study, patients were followed-up with the measurement of depressive symptoms through the BDI-II, in 3 different times along the psychotherapeutic monitoring (before starting, during, and after finishing). Also blood collections were performed to measure serum levels of three neurotrophins, which are factors of neuronal growth and development that can be associated with depressive symptoms and the course of the disorder, which were: Brain-Derived Neurotrophic Factor (BDNF), Glial cell-line Derived Neurotrophic Factor (GDNF) and beta-Nerve Growth Factor (NGF). Results: In the first study, it were not observed significantly differences between NGF levels, depressive symptoms and sexual roles. For the second study, patients had a significant change of severity symptoms after the treatment. It was not verified associations between depressive scores at Beck Depression Inventory II (BDI) and any independent variable, with statistical significance. Also, no correlations were observed between BDNF and GDNF levels, neither depressive scores at BDI pre-treatment and post-treatment, but we found a tendency of having statistical significance on the NGF levels. Conclusion: BDNF, NGF and GDNF were not influenciable by psychotherapy effects in symptomatology reduction.