Hostname: page-component-8448b6f56d-t5pn6 Total loading time: 0 Render date: 2024-04-25T04:54:48.484Z Has data issue: false hasContentIssue false
  • English
  • Français

Neuroendocrine aspects of primary endogenous depression III. Cortisol secretion in relation to diagnosis and symptom patterns

Published online by Cambridge University Press:  09 July 2009

Robert T. Rubin ,
Russell E. Poland ,
Ira M. Lesser ,
David J. Martin ,
A. L. Nelson Blodgett  and
Robert A. Winston
Robert T. Rubin*
Affiliation:
Department of Psychiatry, Harbor-UCLA Medical Center, Torrance, California, USA
Russell E. Poland
Affiliation:
Department of Psychiatry, Harbor-UCLA Medical Center, Torrance, California, USA
Ira M. Lesser
Affiliation:
Department of Psychiatry, Harbor-UCLA Medical Center, Torrance, California, USA
David J. Martin
Affiliation:
Department of Psychiatry, Harbor-UCLA Medical Center, Torrance, California, USA
A. L. Nelson Blodgett
Affiliation:
Department of Psychiatry, Harbor-UCLA Medical Center, Torrance, California, USA
Robert A. Winston
Affiliation:
Department of Psychiatry, Harbor-UCLA Medical Center, Torrance, California, USA
*
1Address for correspondence: Dr R. T. Rubin, Department of Psychiatry, Harbor-UCLA Medical Center, Torrance, CA 90509, USA
Get access Rights & Permissions [Opens in a new window]

Synopsis

In order to ascertain the extent of hypothalamo-pituitary-adrenal cortical (HPA) hyperactivity in endogenous depression, we determined circadian serum cortisol patterns, cortisol responses to dexamethasone (DEX) administration, and urine free cortisol excretion before and after DEX administration in 40 definite endogenous depressives diagnosed with the Research Diagnostic Criteria. The cortisol measures ranged from normal to clearly elevated. To elucidate the clinical correlates of these hormone measures in the patients, we examined the relationships of the pre- and post-DEX cortisol measures to the diagnosis of endogenous/melancholic depression by different systems and to the overall severity and specific dimensions of depressive symptomatology.

In this group of endogenous depressives, none of the diagnostic schemes for endogenous/melancholic depression which we studied was significantly related to the pre- or post-DEX cortisol measures. Of the other subject and symptom variables, only age and the agitation/anxiety factor of the Hamilton depression scale showed consistent relationships with the cortisol measures. Both were positively correlated, to a moderate degree, with the hormone measures, and they were not correlated with each other. Together they explained approximately 20% of the variance in the cortisol measures. Thus, within a group of moderately to severely ill endogenous depressives, the older and the more agitated anxious patients have a significantly greater likelihood of showing increased HPA activity. These findings indicate that age should be controlled in studies of the HPA axis and that the subjective experience of anxiety may contribute to HPA hyperactivity in endogenous depression.

Type
Research Article
Information
Psychological Medicine , Volume 17 , Issue 3 , August 1987 , pp. 609 - 619
Copyright
Copyright © Cambridge University Press 1987

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1980). Diagnostic and Statistical Manual of Mental Disorders (third edn). APA Press: Washington, D.C.Google Scholar
Andreasen, N C, Sheftner, W., Reich, T., Hirschfeld, R M. A, Endicott, J. & Keller, M. B. (1986). The validation of the concept of endogenous depression: a family study approach. Archives of General Psychiatry 43, 246–251.Google Scholar
Anton, R. F. (1987). Urinary free cortisol in psychotic depression. Biological Psychiatry 22, 24–34.CrossRefGoogle ScholarPubMed
Asnis, G. M., Sachar, E. J., Halbreich, U., Nathan, R. S., Novacenko, H. & Ostrow, L. C. (1981). Cortisol secretion in relation to age in major depression. Psychosomatic Medicine 43, 235–242.CrossRefGoogle ScholarPubMed
Beck, A. T. (1967). Depression: Clinical, Experimental and Theoretical Aspects. Harper and Row London.Google Scholar
Beck, A. T. & Steer, R. A. (1985). Factor Scores for the Beck Depression Inventory. Center for Cognitive Therapy, University of Pennsylvania School of Medicine: Philadelphia, PA.Google Scholar
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J. & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 561–571.Google Scholar
Berger, M. & Klein, H. E. (1984). Der Dexamethason-Suppressions-Test: ein biologischer Marker der endogenen Depression? European Archives of Psychiatry and Neurological Science 234, 137–146.Google Scholar
Berger, M., Doerr, P., Lund, R., Bronish, T. & von Zerssen, D. (1982). Neuroendocrinological and neurophysiological studies in major depressive disorders: are there biological markers for the endogenous subtype? Biological Psychiatry 17, 1217–1242.Google Scholar
Brown, W. A. & Shuey, I. (1980) Response to dexamethasone and subtype of depression. Archives of General Psychiatry 37, 747–751.Google Scholar
Calloway, S. P., Dolan, R. J, Fonagy, P., DeSouza, V. G. A. & Wakeling, A. (1984). Endocrine changes and clinical profiles in depression: I. The dexamethasone suppression test. Psychological Medicine 14, 749–758.Google Scholar
Carney, M. W. P. & Sheffield, B. F. (1972). Depression and the Newcastle scales: their relationship to Hamilton's scale. British Journal of Psychiatry 121, 35–40.Google Scholar
Carney, M. W. P., Roth, M. & Garside, R. F. (1965). The diagnosis of depression syndromes and the prediction of E.C.T. response. British Journal of Psychiatry 111, 659–674.CrossRefGoogle ScholarPubMed
Caroff, S., Winokur, A., Rieger, W., Schweizer, E. & Amsterdam, J. (1983). Response to dexamethasone in psychotic depression. Psychiatry Research 8, 59–64.Google Scholar
Carroll, B. J. (1978). Neuroendocrine function in affective disorders. In Psychopharmacology: A Generation of Progress (ed. Lipton, M. A., DiMascio, A., & Killam, K. G.), pp. 487–497. Raven Press: New York.Google Scholar
Carroll, B. J. (1982). The dexamethasone suppression test for melancholia. British Journal of Psychiatry 140, 292–304.Google Scholar
Carroll, B. J. (1985). Dexamethasone suppression test: a review of contemporary confusion. Journal of Clinical Psychiatry 46, 13–24.Google Scholar
Carroll, B. J., Curtis, G C., Davies, B. M., Mendels, J. & Sugerman, A. A. (1976 a). Urinary free cortisol excretion in depression. Psychological Medicine 6, 43–50Google Scholar
Carroll, B. J., Curtis, G. C. & Mendels, J. (1976 b). Neuroendocrine regulation in depression. II. Discrimination of depressed from non-depressed patients. Archives of General Psychiatry 33, 1051–1058.Google Scholar
Carroll, B. J., Feinberg, M., Greden, J. F., Tarika, J., Albala, A. A., Haskett, R. F., James, N. M., Kronfol, Z., Lohr, N., Steiner, M., de Vigne, J. P. & Young, E. (1981). A specific laboratory test for the diagnosis of melancholia: standardization, validation, and clinical utility. Archives of General Psychiatry 38, 15–22.Google Scholar
Chang, P. C., Rubin, R. T. & Yu, M. (1975). Optimal statistical design of radioimmunoassay and competitive protein-binding assays. Endocrinology 96, 973–981.CrossRefGoogle ScholarPubMed
Christie, J. E., Whalley, L. J., Dick, H., Blackwood, D. H. R., Blackburn, I. M. & Fink, G. (1986). Raised plasma cortisol concentrations a feature of drug-free psychotics and not specific for depression. British Journal of Psychiatry 148, 58–65.Google Scholar
Coccaro, E. F., Prudic, J., Rothpearl, A. & Nurnberg, H. G. (1984). Effect of hospital admission on DST results. American Journal of Psychiatry 14, 982–985.Google Scholar
Copolov, D. L., Rubin, R. T., Mander, A. J., Sashidharan, S. P., Whitehouse, A. M., Blackburn, I. M., Freeman, C. P., Blackwood, D. H. R., Lane, L. A. & Poland, R. E. (1985). Pre- and post-dexamethasone salivary cortisol concentrations in major depression. Psychoneuroendocrinology 10, 461–467.CrossRefGoogle ScholarPubMed
Copolov, D. L., Rubin, R. T., Mander, A. J., Sashidharan, S. P., Whitehouse, A. M., Blackburn, I. M., Freeman, C. P. & Blackwood, D. H. R. (1986). DSM-III melancholia: do the criteria accurately and reliably distinguish endogenous pattern depression? Journal of Affective Disorders 10, 191–202.Google Scholar
Davidson, J., Lipper, S., Zung, W. W. K., Strickland, R., Krishnan, R. & Mahorney, S. (1984 a). Validation of four definitions of melancholia by the dexamethasone suppression test. American Journal of Psychiatry 141, 1220–1223.Google ScholarPubMed
Davidson, J., Turnbull, C., Strickland, R. & Belyea, M. (1984 b). Comparative diagnostic criteria for melancholia and endogenous depression. Archives of General Psychiatry 41, 506–511.Google Scholar
Davidson, J., Strickland, R., Turnbull, C, Belyea, M. & Miller, R D (1984 c) The Newcastle endogenous depression diagnostic index: validity and reliability. Acta Psychiatrica Scandinavica 69, 220–230.Google Scholar
Davis, K. L., Davis, B. M., Mathe, A. A., Mohs, R. C., Rothpearl, A. B., Levy, M. I., Gorman, L. K. & Berger, P. (1984). Age and the dexamethasone suppression test in depression. American Journal of Psychiatry 141, 872–874.Google ScholarPubMed
Dommisse, C. S., Hayes, P. E & Kwentus, J. A. (1985). Effect of estrogens on the dexamethasone suppression test in nondepressed women. Journal of Clinical Psychopharmacology 5, 315–319.Google Scholar
Endicott, J. & Spitzer, R. L. (1978). A diagnostic interview: the schedule for affective disorders and schizophrenia. Archives of General Psychiatry 35, 837–844.Google Scholar
Endicott, J. & Spitzer, R. L. (1979). Use of the research diagnostic criteria and the schedule for affective disorders and schizophrenia to study affective disorders. American Journal of Psychiatry 136, 52–56.Google Scholar
Evans, D. L., Burnett, B. G. & Nemeroff, C. B. (1983). The dexamethasone suppression test in the clinical setting. American Journal of Psychiatry 140, 586–589.Google Scholar
Everitt, B. S. (1975). Multivariate analysis: the need for data, and other problems. British Journal of Psychiatry 126, 237–240.Google Scholar
Feinberg, M. & Carroll, B. J. (1984). Biological ‘markers’ for endogenous depression: effect of age, severity of illness, weight loss, and polarity. Archives of General Psychiatry 41, 1080–1085.Google Scholar
Foster, L. B. & Dunn, R. T. (1974). Single antibody technique for radioimmunoassay of cortisol in unextracted serum or plasma. Clinical Chemistry 20, 365–368.Google Scholar
Halbreich, U., Asnis, G. M., Zumoff, B., Nathan, R. S. & Schindledecker, R. (1984). Effect of age and sex on cortisol secretion in depressives and normals. Psychiatry Research 13, 221–229.Google Scholar
Hamilton, M. (1967). Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology 6, 278–296.Google Scholar
Hedlund, J. L. & Vieweg, B. W. (1979). The Hamilton rating scale for depression: a comprehensive review. Journal of Operational Psychiatry 10, 149–165.Google Scholar
Holden, N. L. (1983). Depression and the Newcastle scale: their relationship to the dexamethasone suppression test. British Journal of Psychiatry 142, 505–507.Google Scholar
Holsboer, F., Bender, W., Benkert, O., Klein, H. E. & Schmauss, M. (1980). Diagnostic value of dexamethasone suppression test in depression. Lancet ii, 706.Google Scholar
Jacobs, K. W. (1976). A table for the determination of expenmentwise error rate (alpha) from independent comparisons. Educational and Psychological Measurement 36, 899–903.CrossRefGoogle Scholar
Kasper, S. & Beckmann, H. (1983). Dexamethasone suppression test in a pluridiagnostic approach: its relationship to psychopathological and clinical variables. Acta Psychiatrica Scandinavica 68, 31–37.Google Scholar
Kendell, R. E. (1982). The choice of diagnostic criteria for biological research. Archives of General Psychiatry 39, 1334–1339.Google Scholar
Klein, H. E., Seibold, B., Bender, W., Nedopil, N., Albus, M. & Schmauss, M. (1984). Postdexamethasone prolactin and cortisol: a biological state variable in depression. Acta Psychiatrica Scandinavica 70, 239–247.Google Scholar
Kline, M. D. & Beeber, A. R. (1983). Weight loss and the dexamethasone suppression test. Archives of General Psychiatry 40, 1034–1035.Google Scholar
Kocsis, J. H., Brockner, N., Butler, T., Fanelli, C. & Stokes, P. E. (1984). Dexamethasone suppression in major depression. Biological Psychiatry 19, 1255–1259.Google Scholar
Lewis, D. A., Pfohl, B., Schlechte, J. & Coryell, W. (1984). Influence of age on the cortisol response to dexamethasone. Psychiatry Research 13,213–220.Google Scholar
Mullen, P. E., Linsell, C. R. & Parker, D. (1986). Influence of sleep disruption and calorie restriction on biological markers for depression. Lancet ii, 1051–1055.CrossRefGoogle Scholar
Murphy, B. E. P. (1968). Clinical evaluation of urinary cortisol determination by competitive protein-binding radioassay. Journal of Clinical Endocrinology and Metabolism 28, 343–348.Google Scholar
Nasr, S. J. & Gibbons, R. D. (1983). Depressive symptoms associated with dexamethasone resistance. Psychiatry Research 10, 183–189.CrossRefGoogle ScholarPubMed
Nasr, S. J., Pandey, G., Altman, E. G., Gibbons, R., Gaviria, F. M. & Davis, J. M. (1983). Symptom profile of patients with positive DST: a pilot study. Biological Psychiatry 18, 571–574.Google Scholar
Nelson, W. H., Khan, A., Orr, W. W. Jr. & Tamragouri, R. N. (1984). The dexamethasone suppression test: interaction of diagnosis, sex and age in psychiatric inpatients. Biological Psychiatry 19, 1293–1304.Google Scholar
Oxenkrug, G. F., Pomara, N., McIntyre, I. M., Branconnier, R. J., Stanley, M. & Gershon, S. (1983). Aging and cortisol resistance to suppression by dexamethasone: a positive correlation. Psychiatry Research 10, 125–130.Google Scholar
Poland, R. E. & Rubin, R. T. (1982). Saliva cortisol levels following dexamethasone administration in endogenously depressed patients. Life Sciences 30, 177–181.Google Scholar
Poland, R. E., Rubin, R. T., Lane, L. A., Martin, D. J., Rose, D. E. & Lesser, I. M. (1985). A modified dexamethasone suppression test for endogenous depression. Psychiatry Research 15, 293–299.Google Scholar
Poland, R. E., Rubin, R. T., Lesser, I. M., Lane, L. A. & Hart, P. J. (1987). Neuroendocrine aspects of primary endogenous depression II. Serum dexamethasone concentrations and hypothalamopituitary- adrenal cortical activity as determinants of the dexamethasone suppression test response. Archives of General Psychiatry (in the press).Google Scholar
Reus, V. I. (1982). Pituitary-adrenal disinhibition as the independent variable in the assessment of behavioral symptoms. Biological Psychiatry 17, 317–326.Google ScholarPubMed
Rhoades, H. M. & Overall, J. E. (1983). The Hamilton Depression Scale: factor scoring and profile classification. Psychopharmacology Bulletin 19, 91–96.Google Scholar
Rosenbaum, A. H., Schatzberg, A F., MacLaughlin, R. A., Snyder, K., Jiang, N.-S., Ilstrup, D., Rothschild, A. J. & Kliman, B. (1984) The dexamethasone suppression test in normal control subjects: comparison of two assays and effect of age. American Journal of Psychiatry 14, 1550–1555.Google Scholar
Roth, M., Gurney, C. & Mountjoy, C. Q. (1983). The Newcastle rating scales. Acta Psychiatrica Scandinavica Supp. 310, 42–54.Google Scholar
Roy-Byrne, P., Gwirtzman, H., Sternbach, H. & Gerner, R. H. (1984). Effects of acute hospitahzation on the dexamethasone suppression and TRH stimulation tests. Biological Psychiatry 19, 607–612.Google Scholar
Rubin, R. T. & Mandell, A. J. (1966). Adrenal cortical activity in pathological emotional states: a review. American Journal of Psychiatry 123, 387–400.Google Scholar
Rubin, R. T. & Poland, R. E. (1982). The chronoendocrinology of endogenous depression. In Neuroendocrine Perspectives, Vol. 1 (ed. Muller, E. E. & MacLeod, R. M.), pp 305–337. Elsevier: Amsterdam.Google Scholar
Rubin, R. T. & Poland, R. E. (1983). Neuroendocrine function in depression. In The Origins of Depression Current Concepts and Approaches (ed. Angst, J.), pp. 205–220. Springer: Berlin.Google Scholar
Rubin, R. T. & Poland, R. E. (1984). The dexamethasone suppression test in depression: advantages and limitations. In Biological Psychiatry: Recent Studies (ed. Burrows, G. D., Norman, T. R. & Maguire, K. P.), pp. 76–83. John Libbey: London.Google Scholar
Rubin, R. T., Gouin, P. R. & Poland, R. E. (1973). Biogenic amine metabolism and neuroendocrine function in affective disorders.In Psychiatry: Proceedings of the V World Congress of Psychiatry (ed. de la Fuente, R. & Weisman, M. N.), pp. 1036–1039. Excerpta Medica: Amsterdam.Google Scholar
Rubin, R. T., Poland, R. E., Lesser, I. M., Winston, R. A. & Blodgett, A. L. N (1987). Neurooendocrine aspects of endogenous depression I. Cortisol secretory dynamics in patients and matched control subjects. Archives of General Psychiatry 44, 328–336.Google Scholar
Shapiro, M. F. & Lehman, A. F. (1983). The diagnosis of depression in different clinical settings: an analysis of the literature on the dexamethasone suppression test. Journal of Nervous and Mental Disease 171, 714–720.Google Scholar
Spitzer, R. L., Endicott, J. & Robins, E. (1978) Research diagnostic criteria: rationale and reliability. Archives of General Psychiatry 35, 773–782.Google Scholar
Stokes, P. E., Stoll, P. M., Koslow, S. H., Maas, J. W., Davis, J. M., Swann, A. C. & Robins, E. (1984). Pretreatment DST and hypothalamic-pituitary-adrenocortical function in depressed patients and comparison groups: a multicenter study. Archives of General Psychiatry 41, 257–267.Google Scholar
von Zerssen, D. & Doerr, P. (1980). The role of the hypothalamopituitary-adrenocortical system in psychiatric disorders. Advances in Biological Psychiatry 5, 85–106.CrossRefGoogle Scholar
Zimmerman, M., Coryell, W., Pfohl, B. & Stangl, D. (1985 a). Four definitions of endogenous depression and the dexamethasone suppression test. Journal of Affective Disorders 8, 37–45.Google Scholar
Zimmerman, M., Stangl, D. & Coryell, W. (1985 b). The Research Diagnostic Criteria for endogenous depression and the dexamethasone suppression test: a discriminant function analysis. Psychiatry Research 14, 197–208.CrossRefGoogle Scholar
Zimmerman, S. L. & Ostrow, D. G. (1986). Differentiating DST suppressors from nonsuppressors: a discriminant function analysis of clinical symptoms. Psychiatry Research 17, 183–193.Google Scholar