Original article| Volume 37, ISSUE 6, P369-375, March 15, 1995

The psychotropic effects of inhibitors of steroid biosynthesis in depressed patients refractory to treatment

      This paper is only available as a PDF. To read, Please Download here.
      Twenty patients, diagnosed as suffering from treatment-resistant major depression, were treated with one or more drugs that decrease corticosteroid biosynthesis. Nine were psychotic, 11 nonpsychotic. Seventeen completed the treatment (8 psychotic, 9 nonpsychotic); 13 responded (5 psychotic, 8 nonpsychotic; 11 responded completely (i.e., a drop in the Hamilton Depression Scale of at least 50%, to ≤ 15), and 2 responded partially. The mean age of the responders (45.2 ± 12.6 years) did not differ significantly from that of the nonresponders (48.7 ± 12/3). Data were analyzed in the following categories; (1) the presence or absence of psychosis, (2) response or nonresponse to treatment, and (3) the drug(s) used (aminoglutethimide, ketoconazole, or a combination of either of these with metyrapone). The patients improved over time on the Hamilton Depression Scale independent of the medication used. Responders demonstrated improvement in mood, insomnia, anxiety, diurnal variation, paranoia and obsessive compulsiveness. Nonpsychotics responded better than psychotics.

      Key Words

      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 access
      One-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 to Biological Psychiatry
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Murphy BEP
        Steroids and depression.
        J Steroid Biochem Molec Biol. 1991; 38: 537-558
        • Murphy BEP
        Treatment of major depression with steroid suppressive therapy.
        J Steroid Biochem Molec Biol. 1991; 39: 239-244
        • Murphy BEP
        • Dhar V
        • Ghadirian AM
        • Chouinard G
        • Keller R
        Response to steroid suppression in major depression resistant to antidepressant therapy.
        J Clin Psychopharmacol. 1991; 11: 121-126
        • Murphy BEP
        • Dhar V
        • Ghadirian AM
        • Chouinard G
        • Keller R
        Medical steroid suppression: answer to Letter to the Editor.
        J Clin Pharmacol. 1992; 12: 142-144
        • Hamilton M
        A rating scale for depression.
        J Neurol Neurosurg Psychiatry. 1960; 23: 55-62
        • Jeffcoate WJ
        • Rees LH
        • Tomlin S
        • Jones AE
        • Edwards CRW
        • Besser GM
        Metyrapone in long-term management of Cushing's disease.
        Br Med J. 1977; 2: 215-217
        • Horky K
        • Kuchel O
        Aminoglutethimide (Elipten CIBA) — A new inhibitor of steroid biosynthesis.
        Ann Intern Med. 1969; 770: 866-867
        • Shaw MS
        • Nicholls PJ
        • Smith JH
        Aminoglutethimide and ketoconazole: Historical perspectives and future prospects.
        J Steroid Biochem. 1988; 31: 137-146
        • Sonino N
        The use of ketoconazole as an inhibitor of steroid production.
        New Engl J Med. 1987; 317: 812-818
        • Murphy BEP
        • Wolkowitz OM
        The pathophysiologic significance of hyperadrenocorticism: Antiglucocorticoid strategies.
        Psychiat Ann. 1993; 23: 682-690
        • Murphy BEP
        • Filipini D
        • Ghadirian AM
        Possible use of glucocorticoid antagonists in the treatment of major depression: preliminary results using RU 486.
        J Psychiat Neurosci. 1993; 18: 209-213
        • Guscott R
        • Grof P
        The clinical meaning of refractory depression: a review for the clinician.
        Am J Psychiatry. 1991; 148: 695-704
        • Pfeiffer A
        • Veilleux S
        • Barden N
        Antidepressant and other centrally acting drugs regulate glucocorticoid receptor messenger RNA levels in rat brain.
        Psychoneuroendocrinology. 1991; 16: 505-515