Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-22T21:58:31.277Z Has data issue: false hasContentIssue false
  • English
  • Français

Exploration de l’influence noradrénergique (par le dosage du MHPG urinaire) sur le test de freinage à la dexaméthasone chez les déprimés

Published online by Cambridge University Press:  28 April 2020

H. Lôo ,
M.F. Poirier ,
T. Dennis ,
C. Benkelfat ,
J.M. Vanelle ,
J.P. Olié ,
S. Askienazy  and
B. Scatton
H. Lôo
Affiliation:
Professeur de Psychiatrie. Chef du Service Hospitalo-Universitaire de Santé Mentale et de Thérapeutique Hôpital Sainte Anne, 1, rue Cabanis – 75674 , Paris Cédex 14
M.F. Poirier
Affiliation:
Chargé de Recherehe Inserm. Service Hospitalo-Universitaire de Santé Mentale et de Thérapeutique Hôpital Sainte Anne, 1, rue Cabanis – 75674 , Paris Cédex 14
T. Dennis
Affiliation:
Ph. D. Groupe de Biochimie Pharmacologique, Laboratoires d'Études et de Recherches Synthélabo 31, avenue Paul Vaillant Couturier – 92220 , Bagneux
C. Benkelfat
Affiliation:
Attaché de Recherche. Service Hospitalo-Universitaire de Santé Mentale et de Thérapeutique Hôpital Sainte Anne, 1, rue Cabanis – 75674 , Paris Cédex 14
J.M. Vanelle
Affiliation:
Assistant des Hôpitaux Psychiatriques, Service du Docteur Pascal – 60 Clermont de L'oise
J.P. Olié
Affiliation:
Praticien du cadre Hospitalier. Service Hospitalo-Universitaire de Santé Mentale et de Thérapeutique Hôpital Sainte Anne, 1, rue Cabanis – 75674 , Paris Cédex 14
S. Askienazy
Affiliation:
Chef du Service de Médecine Nucléaire, Hôpital Sainte Anne, 1, rue Cabanis – 75674Paris Cédex 14
B. Scatton
Affiliation:
Ph. D. Groupe de Biochimie Phamiacologique, Laboratoires d'Études et de Recherches Synthélabo 31, avenue Paul Vaillant Couturier – 92220 , Bagneux
Get access

Résumé

Une hyperactivité de l’axe hypothalamo-hypophyso-cortico-surrénalien est souvent objectivée dans les dépressions majeures ou endogènes, particulièrement par le test de freinage à la dexaméthasone (DST).

Certaines hypothèses évoquent un dysfonctionnement noradrénergique pour expliquer cette anomalie.

Afin de rechercher les liens entre l’axe HPA et une anomalie du métabolisme de la noradrénaline (NA) cérébrale, 47 déprimés majeurs ont été étudiés.

Pour chaque déprimé étaient mesurés l’excrétion urinaire du MHPG de 24 heures et un test de freinage à la dexaméthasone était effectué.

Aucune corrélation n’est retrouvée entre l’âge et la sévérité de la dépression d’une part et d’autre part, l’excrétion du MHPG et les chiffres de cortisolémie pré et post dexaméthasone. Par contre, il existe une corrélation positive entre l’âge et l’excrétion du MHPG et entre l’âge et la cortisolémie post dexaméthasone, entre la durée du sevrage thérapeutique et la cortisolémie pré dexaméthasone et surtout, entre la cortisolémie pré DST et post DST.

Aucune corrélation ne peut âtre retrouvée entre l’excrétion du MHPG et la cortisolémie maximale post dexaméthasone.

Il n’y a pas de différence d’excrétion urinaire du MHPG entre les suppresseurs et les non suppresseurs qui sont au nombre de 19 (40 %).

Lorsque les déprimés sont séparés en hauts excréteurs et bas excréteurs de MHPG, il existe une tendance significative des déprimés hauts excréteurs à présenter un pourcentage supérieur de non suppresseurs.

L’étude ne confirme pas l’hypothèse hyponoradrénergique de l’échappement à la dexaméthasone. Elle tend plutôt à démontrer une association entre une hyperactivité de l’axe HPA et une excrétion urinaire élevée de MHPG.

De nombreux facteurs peuvent peut-âtre expliquer les difficultés à mettre en évidence les liens entre l’échappement au freinage par la dexaméthasone et une anomalie du métabolisme de NA cérébrale lorsque des mesures biologiques périphériques sont utilisées.

Summary

Summary

A hyperactivity of the hypothalamic -pituitary - adrenocortical axis (H.C.A.) has often been substantiated in major or endogenous depressions, particurlarly in the Dexamethasone Suppression Test (D.S.T.). Some authors have hypothesized noradrenergic (NA) dysfunctioning to explain this abnormality.

In order to define the links between the H.P.A. axis and abnormal brain NA metabolism, 47 major depressed patients were studied.

For each depressed patient 24 h. urinary M.H.P.G. excretion was measured and a D.S.T. was performed.

No correlation was found between age and severity of depression on the one hand, and M.H.P.G. excretion and pre and post Dexamethasone plasma cortisol on the other hand.

However, there was a positive correlation between age and M.H.P.G. excretion, between age and post Dexamethasone plasma cortisol, between therapeutic washout duration and pre Dexamethasone plasma cortisol and, above all, between pre D.S.T. plasma cortisol and post D. S. T. plasma cortisol.

No correlation could be found between M.H.P.G. excretion and maximal post Dexamethasone plasma cortisol.

There was no difference in the M.H.P G. urinary excretion between suppressors and non suppressors (N = 19.40%). When depressed patients were distributed into high and low M.H.P.G. excretors, high excretors significantly included a higher percentage of non suppressors.

This study did not confirm the hypothesis of a link between NA deficiency and escape to Dexamethasone. Rather it tends to point out an association between a hyperactivity of the H.P.A. axis and a high excretion of urinary M.H.P.G. A number of factors may explain the difficulties in clarifying the links between the escape to D.S.T and abnormal brain NA metabolism as evidenced by peripheral biological measures.

Keywords

Déprimé majeurMHPGTest de freinage à la dexaméthasoneNoradrénalineMajor depressedM.H.P.G.Dexamethasone Suppression TestNoradrenaline
Type
Research Article
Information
Psychiatry and Psychobiology , Volume 1 , Issue 4 , 1986 , pp. 298 - 308
Copyright
Copyright © European Psychiatric Association 1986

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

Bibliographie/References

American Psychiatric Association.- Diagnostic and statistical Manual of Mental Disorders. 3rd ed DSM III, Washington DC, 1980.Google Scholar
Amsterdam, J.D., Winokur, A., Bryant, S., Larkin, J., Rickels, K.- The Dexamethasone Suppression Test as a Predictor of Antidepressant Response. Psychopharmacology 1983;80:43–45.CrossRefGoogle ScholarPubMed
Barnes, R.F., Veith, R.C., Borson, S., Verhey, J., Raskind, M.A., Halter, J.B.- High Levels of Plasma Catecholamines in Dexamethasone-Resistant Depressed Patients. Am J Psychiatry 1983; 140: 1623–1625Google ScholarPubMed
Berger, M., Pirke, K.M., Doerr, P., Krieg, J.C.. Von Zerssen D.- The limited Utility of the Dexamethasone Suppression Test for the Diagnostic Process in Psychiatry. Br J Psychiatry 1984;145:372–382.10.1192/bjp.145.4.372CrossRefGoogle Scholar
Blomberg, P.A., Kopin, J.J., Gordon, E.K.. Markey, S.P., Ebert, M.H.- Conversion of MHPG to vanillylmandelic acid: Implications for the importance of urinary MHPG. Arch Gen Psychiatry 1980; 37: 1095–1098.CrossRefGoogle Scholar
Braddock, L.- The dexamethasone suppression test. Fact and Artefact. Br J Psychiatry 1986;148:363–374.10.1192/bjp.148.4.363CrossRefGoogle ScholarPubMed
Brown, W.A., Keitner, G., Qualls, B., Haier, R.- The Dexamethasone Suppression Test and Pituitary-Adrenocortical Function. Arch Gen Psychiatry 1985;42:121–123.10.1001/archpsyc.1985.01790250015001CrossRefGoogle ScholarPubMed
Carroll, B.J., Curtis, G.C., Davies, B.M., Mendels, J., Surgerman, A.- Urinary free cortisol excretion in depression. Psychol Med 1976;6:43–50.10.1017/S0033291700007480CrossRefGoogle ScholarPubMed
Carroll, B.J., Feinberg, M., Greden, J.F., Tarika, M.A., Ariav-Albala, A.A., Haskett, R.F., James, N.M., Kronfol, Z., Lohr, N., Steiner, M., de Vigne, J.P., Young, E.- A specific laboratory test for the diagnosis of melancholia. Arch Gen Psychiatry 1981; 38:15–22.10.1001/archpsyc.1981.01780260017001CrossRefGoogle Scholar
Christensen, L., Kristensen, C.B., Gram, L.F., Christensen, P., Pedersen, O.L., Kragh-Sorensen, P.- Afternoon plasma cortisol in depressed patients: a measure of diagnosis or severity? Life Sci 1983;32:617–623.10.1016/0024-3205(83)90207-2CrossRefGoogle ScholarPubMed
Davis, K.L., Hollister, L.E., Mathe, A.A., Davis, B.M., Rothpearl, A.B., Faul, K.F., Hsich, J.Y.K., Barchas, J.D., Berger, P.A. - Neurocndocrine and Neurochemical Measurements in Depression. Am J Psychiatry 1981; 138: 1555–1562.Google ScholarPubMed
Ennis, J., Barnes, R.E., Kennedy, S. - The Dexamethasone Suppression Test and Suicidal Patients. Br J Psychiatry 1985; 147:419–423.10.1192/bjp.147.4.419CrossRefGoogle ScholarPubMed
Garver, D.L. et DavisJ.M., - Biogenic amine hypotheses of affective disorders. Life Sci 1979; 24: 383–394.10.1016/0024-3205(79)90208-XCrossRefGoogle ScholarPubMed
Few, D., Gawl, M.J., Imms, F.J.- The influcnce of the infusion of noradrenaline on plasma control levels in man. J Physiol 1980;309:375–389.10.1113/jphysiol.1980.sp013514CrossRefGoogle Scholar
Gold, P.W., Extein, I., Pickar, D., Rebar, R., Ross, R., Goodwin, F.K.- Suppression of plasma cortisol in depressed patients by acute intravenous methadone infusion. Am J Psychiatry 1980; 137: 862–863.Google Scholar
Halaris, A.- Circadian patterns of plasma 3-methoxy-4-hydroxyphenylglycol (MHPG) in normal and depressed subjects. Ann Rev Chronopharmacol 1984;1:33–37.Google Scholar
Jimerson, D.C., Insel, T.R., Reus, V.I., Kopin, F.J.- Increased Plasma MHPG in Dexamethasone-Resistant Depressed Patients. Arch Gen Psychiatry 1983; 20: 173–176.10.1001/archpsyc.1983.01790020067006CrossRefGoogle Scholar
Kraus, R.P., Hux, M., Grof, P.- Drug withdrawal and the dexamethasone suppression test. Am J Psychiatry 1987 (in press).Google Scholar
Leckman, J.F., Maas, J.W.- Relationship to brain noradrenergic systems and emerging clinical applications, in: Post, R.M., Ballenger, J.C. (eds): Neurobiology of Mood Disorders, 529-537, Williams and Wilkins, Baltimore, London, 1984.Google Scholar
Linnoila, M., Karoum, F., Miller, T., Potter, W.Z.- Reliability of urinary monoaminc and metabolite output measurements in depressed patients. Am J Psychiatry 1983;140:1025–102.Google Scholar
Loo, H., Benkelfat, C., Scatton, B., Susini de Lucas, H., Dennis, T., Poirier, M.F., Gay, C.- Plasma 3,4-dihydroxyphenylethyleneglycol levels in depressed patients with and without abnormal dexamethasone suppression. Neuropsychobiology 1986; 15:68–72.10.1159/000118244CrossRefGoogle ScholarPubMed
Loo, H, Dennis, T., Vanelle, J.M., Rouquier, L., Poirier-LittrÉ, M.F., Garreau, M., Benkelfat, C., Sechter, D” Scatton, B.- Lack of correlation between plasma DOPEG and urinary MOPEG levels in depressed patients. Biol Psychiatry 1986b; 21: 900–906.10.1016/0006-3223(86)90263-5CrossRefGoogle Scholar
Maas, J.W.- MHPG: Basic Mechanisms and Psychopathology. Academic Press INC, New York, London, Paris, p 226, 1983.Google Scholar
Pepper, G.M., Krieger, D.T.- Hypothalamic-Pituitary-Adrcnal Abnormalities in Depression: Their Possible Relation to Central Mechanisms Regulating ACTH Release, in: Post, R.M., Ballenger, J.C. eds: Neurobiology of Mood Disorders, 245-270, Williams and Wilkins. Baltimore, London, 1984.Google Scholar
Potter, W.Z., Muscettola, G., Goodwin, F.K.- Sources of Variance in Clinical Studies of MHPG, in: MAAS, J.W. ed.: MHPG: Basic Mechanisms and Psychopathology, 145-165, Academic Press. New york, London, 1983.Google Scholar
Pull, C.B., Guelfi, J.D., Boyer, P., Pull, M.C.- Les critères diagnostiques en psychiatrie : historique, état actuel et perspectives d'avenir. Masson ed., Paris, 196, 1986.Google Scholar
Rosenbaum, A.M., Maruta, T., Schatzberg, A.F., Orsulak, P.J., Jiang, N.S., Cole, J.O., Schildkraut, J.J.- Toward a Biochemical Classification of Depressive Disorders: Urinary Free Cortisol and Urinary MHPG in Depressions. Am J Psychiatry 1983;140:314–318.Google Scholar
Roy-Byrne, P., Gwirtsman H., Sternbach H., Gerner R.H.- Effects of acute hospitalisation on the dexamethasone suppression test and TRH stimulation tests. Biol Psychiatry 1984;19:607–612.Google Scholar
Rubin, A.L., Price, L.H., Charney, D.S., Heninger, G.R.- Noradrenergic Function and the Cortisol Responso to Dexamethasone in Depression. Psychiatry Res 1985; 15:5–15.10.1016/0165-1781(85)90034-4CrossRefGoogle Scholar
Rubinow, D.R., Post, R.M., Gold, P.W., Ballenger, J.C., Wolff, E.A.- The Relationship between Cortisol and Clinical Phenomenology of Affective Illness, in: Post, R.M., Ballenger, J.C. eds - Neurobiology of Mood Disorders, 271-289, Williams and Wilkins. Baltimore, London, 1984.Google Scholar
Sachar, E.J.- Neuroendocrine dysfunction in depressive illness. Ann Rev Med 1976; 27: 389–396.10.1146/annurev.me.27.020176.002133CrossRefGoogle ScholarPubMed
Sachar, E.J., Asnis, G., Nathan, R.S., Halbreich, U., Trabizi, M.A., Halpern, F.S.- Dextroamphetamine and Cortisol in Depression. Arch Gen Psychiatry 1980; 37:755–757.10.1001/archpsyc.1980.01780200033003CrossRefGoogle ScholarPubMed
Scapagnini, U., Van Loon, G.R., Moberg, G.P., Preziosi, P., Ganong, W.F.- Evidence for a central norepincphrinergic inhibition of ACTH secretion in the rat. Neuroendocrinology 1972; 10: 155–160.10.1159/000122113CrossRefGoogle ScholarPubMed
Scatton, B - Brain 3,4 dihydroxyphenylethyleneglycol levels are dependent on central noradrenergic activity. Life Sci 1982;31:495–504.10.1016/0024-3205(82)90336-8CrossRefGoogle Scholar
Schildkraut, J.J.- Norcpinephrine Metabolites as biochcmical Criteria for Classifying Depressive Disorders and Predicting Response to Treatment: Preliminary Findings. Am J Psychiatry 1973; 130:695–698.10.1176/ajp.130.6.695CrossRefGoogle Scholar
Schildkraut, J.J.- Current status of the catecholamine hypothesis of affective disorders, in: Lipton, M.A., Di Mascio, A., Killam, F.K. eds: Psychopharmacology, A generation of Progress, 1223-1234, Raven Press, New York, 1978.Google Scholar
Schildkraut, J.J., Orsulak, P.J., Schatzberg, A.F., Rosenbaum, A.H.- Relationship between Psychiatric Diagnostic Groups of Depressive Disorders and MHPG, in: Maas, J.W. ed.: MHPG: Basic Mechanisms and Psychopathology, 129-144, Academic Press, New York, 1983.Google Scholar
Schlesser, M.A., Winokur, G., Sherman, B.M.- Hypothalamic- pituitary adrenal axis activity in depressive illness. Its relationship to classification. Arch Gen Psychiatry 1983;37:737–743.10.1001/archpsyc.1980.01780200015001CrossRefGoogle Scholar
Sternbach, H.A., Extein, L, Sweeney, D.R., Gold, M.S., Pottash, A.L.C.- Cortisol secretion and urinary MHPG in unipolar depression. Int J Psychiatry Med 1983; 13: 261–266.10.2190/N253-M9Y0-E2NA-1W01CrossRefGoogle ScholarPubMed
Stokes, P.E., Frazer, A., Casper, R.- Unexpected Neuroendocrine Transmitter Relationships. Psychopharmacol Bull 1981; 17: 72–75.Google ScholarPubMed
Stokes, P.E., Stoll, P.M., Kaslow, S.H., Maas, J.W., Davis, J.M., Swann, A.C., Robins, E.- Pretreatment DST and hypothalamic- pituitary-adrenocortical function in depressed patients and comparison groups. A multicenter study. Arch Gen Psychiatry 1984;41: 257–267.CrossRefGoogle ScholarPubMed
Tosca, P., Fenoglio, L., Zerbi, F., Romani, A., Bezzi, G., Ferrari, E. and Canipari, C.-Neuroendocrinological effects of depression and symptomatological picture. Psychiatrica Clinica 1982; 15: 153–159.Google Scholar
Warsh, J.J., Hasey, C, Coore, R., Stancer, H.C., Persad, E., Jorna, T., Godse, D.D.- Elevated 3,4 dihydroxyphenylethyleneglycol (DHPG) excretion in dexamethasone resistant depressed patients. Prog Neuropsychopharmacol Biol Psychiatry 1985; 9: 661664.10.1016/0278-5846(85)90036-3CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.