What future for neuroendocrinology in psychiatry?

Summary In psychiatry, neuroendocrine techniques were initially considered a potential “window into the brain” by indirectly marking central nervous system limbic dysfunction. At present this conception has evolved, owing to significant progress over the last decades demonstrating direct involvement of neuropeptides and neurohormones in psychiatric diseases. In a synchronic perspective, neuroendocrine investigations evaluate a functional status at a given moment in the evolution of the disease, which results from both etiopathogenic processes and compensatory homeostatic mechanisms. These vital physiological changes appear to be potential targets for novel hormonally based pharmacotherapies. However, in the past few years, the interest for the study of neuroendocrine dysregulations in psychiatric patients has declined. In order to better understand this relative disinterest, this article will attempt to shed light on strengths and limitations of the neuroendocrine approaches in psychiatry. It is necessary to bear in mind that the usefulness of these techniques in the clinical, pathophysiological and therapeutic fields depends largely on the selectivity of stimuli and the appropriateness of the methodologies used. Owing to the complexity of the clinical phenomena, multifactorial approaches (combining several neuroendocrine challenge tests to imaging, immunological, neurophysiological, neurochemical and/or genetic techniques) are to be privileged in psychiatric investigations. Despite the inherent limitations of these approaches, due to their technical and ethical constraints, the neuroendocrine strategy can inform modern clinical practice and lead to new breakthroughs in future science and practice.