This paper is only available as a PDF. To read, Please Download here.
This study examined the relationship between longitudinal clinical course and sleep
and cortisol findings in adolescent unipolar major depressive disorder (MDD). Subjects
were 28 adolescents (15.4 ± 1.3 years) systematically diagnosed with unipolar MDD
and 35 group-matched normal controls who participated in EEG sleep and neuroendocrine
studies. Follow-up clinical assessments were conducted 7.0 ± 0.5 years later in 94%
of the original cohort. Although initial group comparisons failed to show significant
differences in biologic measures, analyses incorporating clinical follow-up reveal
that changes in sleep and cortisol measures are associated with differential longitudinal
course. Normal controls who would develop depression after the biologic studies had
shown significantly higher density of rapid eye movements (REM) and a trend for reduced
REM latency compared to controls with no psychiatric disorder at follow-up. Depressed
subjects with a recurrent unipolar course showed a trend towards elevated plasma cortisol
near sleep onset compared to MDD subjects with no further episodes during the follow-up
interval.
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 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
- Bipolar outcome in the course of depressive illness.J Am Acad Child Adol Psychiatry. 1983; 5: 115-128
- 3rd ed. Diagnostic and Statistical Manual of Mental Disorders (DSM-III). American Psychiatric Association, London1980
- 3rd ed rev. Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R). American Psychiatric Association, Washington DC1987
- Depression in adolescents and young adults-polysomnographic and neuroendocrine aspects.J Affect Disord. 1988; 14: 24-40
- Concurrent use of REM latency, dexamethasone suppression, clonidine, and apomorphine tests as biological markers of endogenous depression: A pilot study.Psychiatry Res. 1984; 12: 261-272
- Cortisol secretion in relation to age in major depression.Psychosom Med. 1981; 43: 235-242
- Plasma cortisol secretion and REM period latency in adult endogenous depression.Am J Psychiatry. 1983; 140: 750-753
- Sleep and psychiatric disorders: A meta-analysis.Arch Gen Psychiatry. 1992; 49: 651-668
- Sleep markers for major depressive disorder in adolescent patients.Sleep Res. 1986; 15: 91
- The assessment of affective disorders in children and adolescents by semi-structured interview: Test-retest reliability of the schedule for affective disorders and schizophrenia for school-age children, present episode version.Arch Gen Psychiatry. 1985; 41: 696-702
- Persistent cortisol nonsuppression after clinical recovery predicts symptomatic relapse in unipolar depression.J Affect Disord. 1989; 17: 271-278
- Cortisol secretion in adolescents with major depressive disorder.Acta Psychiatr Scand. 1989; 80: 18-26
- EEG sleep in adolescents with major depression: The role of suicidality and inpatient status.J Affect Disord. 1990; 19: 63-75
- 24-Hour cortisol measures in adolescents with major depression: a controlled study.Biol Psychiatry. 1991; 30: 25-36
- The dexamethasone suppression test in children and adolescents: a review and a controlled study.Biol Psychiatry. 1992; 32: 109-126
- Sleep onset abnormalities in depressed adolescents.Biol Psychiatry. 1995; (in press)
- Age and dexamethasone suppression test in depression.Am J Psychiatry. 1984; 141: 872-874
- Effects of age on delta and REM sleep parameters.Electroencephalogr Clin Neurophysiol. 1989; 72: 118-125
- Sleep EEG features of adolescents with major depression.Biol Psychiatry. 1994; 36: 573-581
- Changes in sleep cycle patterns with age.J Psychiatr Res. 1974; 10: 283-306
- Biological markers for endogenous depression in series and parallel.Biol Psychiatry. 1984; 19: 3-11
- Rate and predictors of prepubertal bipolarity during follow-up of 6- to 12-year-old depressed children.J Am Acad Child Adol Psychiatry. 1994; 33: 461-468
- Sleep parameters in bipolar I, bipolar II, and unipolar depressions.Biol Psychiatry. 1986; 21: 1340-1343
- Reduced rapid eye movement latency: A predictor of recurrence in depression.Neuropsychopharmacology. 1987; 1: 33-39
- Polysomnographic findings and dexamethasone nonsuppression in unipolar depression: A replication and extension.Biol Psychiatry. 1987; 22: 872-882
- Polysomnographic parameters in first-degree relatives of unipolar probands.Psychiatry Res. 1989; 27: 127-136
- Age-adjusted threshold values for reduced REM latency in unipolar depression using ROC analysis.Biol Psychiatry. 1990; 27: 841-853
- EEG sleep abnormalities in depressed children: a hypothesis.Psychiatry Res. 1992; 41: 53-63
- Reduced REM latency: risk factor for first episode of depression.Sleep Res. 1994; 23: 197
- Age-related changes in sleep in depressed and normal subjects.Psychiatry Res. 1981; 4: 73-78
- Electroencephalographic sleep of adolescents with major depression and normal controls.Arch Gen Psychiatry. 1987; 44: 61-68
- EEG sleep of young adults with major depression: a controlled study.J Affect Disord. 1991; 22: 91-100
- Shortened REM latency postECT is associated with rapid recurrence of depressive symptomatology.Biol Psychiatry. 1994; 36: 214-222
- Effect of age and sex on cortisol secretion in depressives and normals.Psychiatry Res. 1984; 13: 221-229
- Cortisol secretion in endogenous depression: I. Basal plasma levels.Arch Gen Psychiatry. 1985; 42: 904-908
- Four cases of reversion to abnormal dexamethasone suppression test response as indicator of clinical relapse: a preliminary report.Biol Psychiatry. 1983; 18: 911-916
- Psychiatric implications of altered limbic-hypothalamic-pituitary-adrenocortical activity.Eur Arch Psychiatr Neurol Sci. 1989; 238: 302-322
- Role of acetylcholine mechanisms in the affective disorders.in: Meltzer HY Psychopharmacology, The Third Generation of Progress. Raven Press, Washington DC1987: 527-533
- Reduced cortisol latency in depressive illness.Arch Gen Psychiatry. 1983; 40: 506-511
- Pathophysiology of HPA axis abnormalities in patients with major depression: an update.Am J Psychiatry. 1989; 146: 311-317
- Age and the dexamethasone suppression test: Results from a broad unselected patient population.Psychiatry Res. 1992; 44: 9-20
- Sleep EEG measures in primary major depressive disorder: Distinction between DST suppressor and nonsuppressor patients.Biol Psychiatry. 1986; 21: 228-232
- Polysomnographic findings in adolescents with major depression.Psychiatry Res. 1990; 33: 313-320
- Age-related changes in sleep in depressed and healthy subjects.Neuropsychopharmacology. 1990; 3: 251-259
- Depressive disorders in childhood: I. A longitudinal prospective study of characteristics and recovery.Arch Gen Psychiatry. 1984; 41: 229-237
- Depressive disorders in childhood: II. A longitudinal study of the risk for a subsequent major depression.Arch Gen Psychiatry. 1984; 41: 643-649
- Stability and change in childhood-onset depressive disorders: longitudinal course as a diagnostic validator.in: Robins LN Barrett JE The Validity of Psychiatric Diagnosis. Raven Press, New York1989: 57-75
- Psychometric, polysomnographic, and neuroendocrine measures in subjects at high risk for psychiatric disorders: preliminary results.Neuropsychobiology. 1990; 23: 57-67
- Relationship among selected neuroendocrine and sleep measures in patients with recurrent depression.Biol Psychiatry. 1984; 19: 1525-1536
- Delta sleep ratio: A biological correlate of early recurrence in unipolar affective disorder.Arch Gen Psychiatry. 1990; 47: 1100-1105
- Nocturnal cortisol, thyroid stimulating hormone, and growth hormone secretory profiles in depressed adolescents.J Am Acad Child Adolesc Psychiatry. 1991; 30: 407-414
- REM latency in endogenously depressed adolescents.Br J Psychiatry. 1992; 161: 399-402
- EEG sleep in depressed adolescents.Am J Psychiatry. 1983; 140: 1150-1153
- From early to late adulthood changes in EEG sleep of depressed patients and healthy volunteers.Biol Psychiatry. 1991; 29: 979-993
- All-night electroencephalographic sleep and cranial computed tomography in depression: a study of unipolar and bipolar patients.Eur Arch Psychiatry Clin Neurosci. 1992; 242: 59-68
- In quest of identifying vulnerability markers for psychiatric disorders by all-night polysomnography.Arch Gen Psychiatry. 1995; 52: 145-153
- Best estimate of lifetime psychiatric diagnosis: a methodological study.Arch Gen Psychiatry. 1982; 339: 879-883
- The 24-hour profile of adrenocorticotropin and cortisol in major depressive illness.J Clin Endocrinol Metab. 1985; 61: 429-438
- Cortisol escape from suppression by dexamethasone during depression is strongly predicted by basal cortisol hypersecretion and increasing age combined.Psychoneuroendocrinology. 1991; 16: 295-310
- Variations in the pattern of pubertal changes in girls.Arch Dis Child. 1969; 44: 291-303
- Variations in the pattern of pubertal changes in boys.Arch Dis Child. 1970; 45: 13
- Depression in young people: Initial presentation and clinical course.J Am Acad Child Adolesc Psychiatry. 1993; 32: 714-722
- Dexamethasone suppression test and REM sleep in patients with major depressive disorder.Br J Psychiatry. 1984; 145: 383-388
- Retrospective assessment of child psychopathology with the K-SADS-E.J Am Acad Child Psychiatry. 1982; 21: 362-397
- Neuroendocrine measures in psychiatric patients: course and outcome with ECT.Psychiatry Res. 1981; 4: 55-64
- Differences in plasma ACTH and cortisol between depressed patients and normal controls.Biol Psychiatry. 1985; 20: 1055-1072
- Relationship between REM sleep latency and nocturnal cortisol concentrations in depressed patients.J Sleep Res. 1992; 1: 54-57
- Unipolar depression in adolescents: clinical outcome in adulthood.J Am Acad Child Adolesc Psychiatry. 1995; 34: 566-578
- A Manual of Standardized Terminology, Techniques, and Scoring System for Sleep Stages of Human Subjects. Publication NIH 204, New York1968
- Sleep research in affective illness: State of the art circa 1987.Sleep. 1987; 10: 199-215
- Open trial maintenance nortriptyline in geriatric depression: survival analysis and preliminary data on the use of REM latency as a predictor of recurrence.Psychopharmacol Bull. 1989; 25: 129-132
- Sleep in adolescents with primary major depression and schizophrenia: a pilot study.J Child Psychol Psychiatry. 1995; 36: 313-326
- Neuroendocrine aspects of primary endogenous depression: I. cortisol secretory dynamics in patients and matched controls.Arch Gen Psychiatry. 1987; 44: 328-336
- Sleep EEG and DST findings in outpatients with unipolar major depressive disorders.Biol Psychiatry. 1982; 17: 327-340
- The dexamethasone suppression test: Identification of subtypes of depression.Am J Psychiatry. 1983; 140: 88-91
- Cholinergic REM sleep induction test in subjects at high risk for psychiatric disorders.Biol Psychiatry. 1992; 32: 79-90
- Prediction of outcome in depressed patients by weekly monitoring with the dexamethasone suppression test.Br J Psychiatry. 1987; 144: 181-184
- An analysis of variance test for normality.Biometrika. 1965; 52 (complete samples): 591-611
- The effect of in or outpatient status on the association of EEG sleep data with post-dexamethasone cortisol levels in depressed patients.Sleep Res. 1989; 18: 185
- The association of supersensitive cholinergic REM-induction and affective illness within pedigrees.J Psychiatry Res. 1987; 21: 487-497
- Research diagnostic criteria: rationale and reliability.Arch Gen Psychiatry. 1978; 35: 773-782
- Schedule for Affective Disorders and Schizophrenia.in: Lifetime Version. New York State Psychiatric Institute, Biometrics Division, Bethesda, MD1978
- Bipolar illness in adolescents with major depression.Arch Gen Psychiatry. 1982; 39: 549-555
- The course of major depressive disorder in adolescents: I. Recovery and risk of manic switching in a follow-up of psychotic and nonpsychotic subtypes.J Am Acad Child Adolesc Psychiatry. 1993; 32: 34-42
- The application of serial neuroendocrine challenge studies in the management of depressive disorder.Biol Psychiatry. 1983; 18: 3-19
- Sleep EEG and DST findings in anergic bipolar depression.Am J Psychiatry. 1989; 146: 329-333
- Effects of aging on EEG sleep in depression.Sleep. 1980; 3: 31-40
- Increased evening activation of the hypothalamic-pituitary-adrenal axis in depressed patients.Arch Gen Psychiatry. 1994; 51: 701-707
Article info
Publication history
Received in revised form:
August 10,
1995
Received:
May 8,
1995
Footnotes
This study was supported in part by Grants MH30915, AA08746 and MH41712.
Identification
Copyright
© 1996 Society of Biological Psychiatry. Published by Elsevier Inc.
