This paper is only available as a PDF. To read, Please Download here.
Abstract
The hypothalamic-pituitary-adrenal (HPA) axis is dysregulated in many patients with
depression, probably at all levels of the axis. To determine if HPA dysregulation
is associated with severity of depression, we studied a group of 66 patients with
major depressive disorder. Each patient underwent a pretreatment Dexamethasone Suppression
Test, with plasma postdexamethasone cortisol determination at 8:00 AM, 4:00 PM, and
11:00 PM. All three postdexamethasone cortisol levels were significantly correlated
with the Hamilton Rating Scale for Depression (HRSD) scores. We also examined the
“profile” measures of mean, maximum, and minimum of the three cortisol values; again,
all three were significantly correlated with HRSD scores. To evaluate associations
between clinical severity and HPA dysregulation at the pituitary level, we studied
a second group of 44 patients with major depressive disorder. Each had postdexamethasone
cortisol determinations at 4:00 PM and 11:00 PM as well as pre- and postdexamethasone
β-endorphin determinations at 4:00 PM. The cortisol data from this group followed
the same pattern as in the first sample, and there was a significant relationship
between HRSD score and degree of β-endorphin nonsuppression as well. These results
suggest that severity of depression is one of the determinants of dysregulation at
both adrenal and pituitary levels of the HPA axis, accounting for 10%–20% of the observed
variance.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Biological PsychiatryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Response to dexamethasone and subtype of depression.Arch Gen Psychiatry. 1980; 37: 747-751
- Cortisol level response to 1- and 2-mg doses of dexamethasone.Am J Psychiatry. 1983; 140: 609-611
- The Dexamethasone Suppression Test and pituitary-adrenocortical function.Arch Gen Psychiatry. 1985; 42: 121-123
- Human plasma β-endorphin-like peptides: A rapid, high recovery extraction technique and validation of radioimmunoassay.J Clin Endocrinol Metab. 1983; 56: 992-997
- A specific laboratory test for the diagnosis of melancholia. Standardization, validation, and clinical utility.Arch Gen Psychiatry. 1981; 38: 15-22
- Plasma and urinary cortisol levels after dexamethasone in affective disorders.J Affect Dis. 1981; 3: 397-406
- Corticotropin releasing factor: Basic and clinical studies.Psychopharmacol Bull. 1983; 19: 416-421
- Age and the Dexamethasone Suppression Test in depression.Am J Psychiatry. 1984; 141: 872-874
- Comparison of competitive protein binding analysis and radioim-munoassay for the determination of cortisol in serum and urine.Clin Biochem. 1977; 10: 104-108
- Effects of antidepressant withdrawal on the Dexamethasone Suppression Test.Psychiatry Res. 1985; 14: 111-122
- Psychiatric implications of basic and clinical studies with corticotropin releasing factor.Am J Psychiatry. 1984; 141: 619-627
- Dexamethasone Suppression Test as indicator of safe withdrawal of antidepressant therapy.Lancet. 1980; i: 376
- A rating scale for depression.J Neurol Neurosurg Psychiatry. 1960; 23: 56-62
- ACTH, cortisol, and corticosterone output after ovine corticotropin releasing factor challenge during depression and after recovery.Biol Psychiatry. 1985; 20: 276-286
- Plasma ACTH and cortisol concentrations before and after dexamethasone.Psychiatry Res. 1982; 7: 87-92
- Results of the Dexamethasone Suppression Test in psychiatric patients with and without weight loss.Am J Psychiatry. 1985; 142: 246-248
- The Dexamethasone Suppression Test in patients with alcoholism.Biol Psychiatry. 1983; 18: 441-450
- What does the Dexamethasone Suppression Test identify?.Biol Psychiatry. 1985; 20: 957-964
- Weight change and the Dexamethasone Suppression Test.Biol Psychiatry. 1985; 20: 1018-1022
- Relationships of the Dexamethasone Suppression Test to clinical severity and degree of melancholia.Biol Psychiatry. 1986; 21: 436-444
- Failure to normalize the Dexamethasone Suppression Test: Association with length of illness.Biol Psychiatry. 1985; 20: 333-337
- Influence of age on the cortisol response to dexamethasone.Psychiatry Res. 1984; 13: 213-220
- Plasma measures of beta-endorphin-like immunoreactivity in depressives and other psychiatric subjects.Life Sci. 1982; 31: 1867-1870
- Beta-endorphin/beta-lipotropin-like immunoreactivity in endogenous depression: Effect of dexamethasone.Arch Gen Psychiatry. 1986; 43: 374-381
- Cortisol determination and the Dexamethasone Suppression Test.Arch Gen Psychiatry. 1983; 40: 501-505
- Some studies of the protein-binding of steroids and their application to the routine micro- and ultra-micro measurement of various steroids in body fluids by competitive protein-binding radioassay.J Clin Endocrinol Metab. 1967; 27: 973-990
- Depressive symptoms associated with dexamethasone resistance.Psychiatry Res. 1983; 10: 183-189
- Symptom profile of patients with positive DST: A pilot study.Biol Psychiatry. 1983; 18: 571-574
- ACTH and the Dexamethasone Suppression Test in depression.Biol Psychiatry. 1983; 18: 1069-1073
- Aging and cortisol resistance to suppression by dexamethasone: A positive correlation.Psychiatry Res. 1983; 10: 125-130
- Pituitary-adrenal axis rhythm disturbances in psychiatric depression.Arch Gen Psychiatry. 1985; 42: 897-903
- Pituitary-adrenal disinhibition as the independent variable in the assessment of behavioral symptoms.Biol Psychiatry. 1982; 17: 317-326
- Dexamethasone Suppression Test in primary depression: Significance of family history and psychosis.Biol Psychiatry. 1982; 17: 41-48
- Depression and anxiety inventories, and the Dexamethasone Suppression Test.Biol Psychiatry. 1984; 19: 1207-1213
- Rhythm-related changes in pituitary-adrenal function in depression.J Affect Dis. 1985; 9: 55-64
- Schedule for Affective Disorders and Schizophrenia.Biometrics Research Division, New York State Psychiatric Institute, New York1975
- Research Diagnostic Criteria (RDC).Biometrics Research Division, New York State Psychiatric Institute, New York1977
- The Dexamethasone Suppression Test during recurrent major depressive episodes.Biol Psychiatry. 1984; 19: 407-412
- The Dexamethasone Suppression Test and unipolar/bipolar distinctions.J Clin Psychiatry. 1985; 46: 461-465
Article info
Publication history
Received in revised form:
November 3,
1986
Received:
May 6,
1986
The authors gratefully acknowledge Pamela Flegel and the CSV staff for their technical assistance and Dr. C. Pomerleau for her helpful suggestions regarding the manuscript.Footnotes
☆Supported in part by NIMH Grants 1 RO1-40216-01 (to J.F.G.) and MH 36168 (to S.J.W.) and by the Mental Health Research Institute, Department of Psychiatry, and the Theophile Raphael Fund at the University of Michigan Medical Center.
Identification
Copyright
© 1987 Published by Elsevier Inc.
