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Consistent Reduction of ACTH responses to stimulation with CRH, Vasopressin and Hypoglycaemia in Patients with Major Depression

Published online by Cambridge University Press:  02 January 2018

Roger G. Kathol ,
Richard S. Jaeckle ,
Juan F. Lopez  and
William H. Meller
Roger G. Kathol*
Affiliation:
College of Medicine, The University of Iowa
Richard S. Jaeckle
Affiliation:
Ohio State University
Juan F. Lopez
Affiliation:
Department of Psychiatry, University of Michigan
William H. Meller
Affiliation:
Assistant Professor of Psychiatry, University of Minnesota
*
∗Iowa City, Iowa 52242, USA
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Abstract

Eleven patients with major depression and 12 control subjects were administered corticotropin-releasing hormone (CRH), aqueous arginine vasopressin (AVP), and insulin hypoglycaemia (IH) to test for differences in hypothalamic–pituitary–adrenal (HPA) axis function. Patients with major depression demonstrated lower ACTH responses to CRH when compared with controls, and a trend toward such after administration of AVP. Despite lower ACTH responses in patients with depression, there were no differences in Cortisol responses to these stimuli. In the CRH and AVP tests, there was no correlation between the basal Cortisol and ACTH responses in either controls or patients, but in the IH test there was a negative correlation between these responses for both groups. The ACTH responses to CRH and AVP were positively correlated in controls and patients. Cortisol responses to all three provocative stimuli were positively correlated in both subject groups. These findings are consistent with the hypothesis that hypothalamic or supra-hypothalamic overactivity may be involved in the development of HPA-axis abnormalities in patients with depression.

Type
Papers
Information
The British Journal of Psychiatry , Volume 155 , Issue 4 , October 1989 , pp. 468 - 478
Copyright
Copyright © Royal College of Psychiatrists 1989 

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References

American Psychiatric Association, Committee on Nomenclature and Statistics (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn). Washington DC: American Psychiatric Association.Google Scholar
Amsterdam, J. D., Winokur, A., Abelman, E., et al (1983) Cosyntropin (ACTHalpha 124) stimulation test in depressed patients and healthy subjects. American Journal of Psychiatry, 140, 907–909.Google Scholar
Amsterdam, J. D., Maislin, G., Winokur, A., et al (1987) Pituitary and adrenocortical responses to the ovine corticotropin releasing hormone in depressed patients and healthy volunteers. Archives of General Psychiatry, 44, 775–781.Google Scholar
Anton, R. F. (1987) Urinary free Cortisol in psychotic depression. Biological Psychiatry, 22, 24–34.CrossRefGoogle ScholarPubMed
Antoni, F. A. (1986) Hypothalamic control of adrenocorticotropin secretion: advances since the discovery of 41-residue corticotropin-releasing factor. Endocrine Reviews, 7, 351–378.CrossRefGoogle ScholarPubMed
Asnis, G. M., Sachar, E. J., Halbreich, U., et al (1981) Cortisol secretion in relation to age in major depression. Psychosomatic Medicine, 43, 235–242.CrossRefGoogle ScholarPubMed
Banki, C. M., Bissette, G., Arato, M., et at (1987) CSF corticotropin-releasing factor-like immunoreactivity in depression and schizophrenia. American Journal of Psychiatry, 144, 873–877.Google ScholarPubMed
Carroll, B. J. (1972) Control of plasma Cortisol levels in depression: studies with the dexamethasone suppression test. In Depressive Illness: Some Research Studies (eds Davies, B., Carroll, B. J. & Mowbray, R. M.). Springfield, Illinois: Charles C. Thomas.Google Scholar
Carroll, B. J. (1976) Psychoendocrine relationships in affective disorders. Modern Trends in Psychosomatic Medicine, 3, 121–153.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., Martin, F. I. R. & Davies, B. (1968) Resistance to suppression by dexamethasone of plasma 11-O.H.C.S. levels in severe depressive illness. British Medical Journal, iii, 285–287.Google Scholar
Carroll, B. J., Curtis, G. L., Davies, B. M., et al (1976) Urinary free Cortisol excretion in depression. Psychological Medicine, 6, 43–50.CrossRefGoogle ScholarPubMed
Carroll, B. J., Feinberg, M., Greden, J. F., et al (1981a) A specific laboratory test for the diagnosis of melancholia. Archives of General Psychiatry, 38, 15–22.CrossRefGoogle ScholarPubMed
Carroll, B. J., Feinberg, M., Smouse, P. E., et al (1982b) The Carroll Rating Scale for Depression: development, reliability, and validation. British Journal of Psychiatry, 138, 194–200.CrossRefGoogle Scholar
Christie, J. E., Whalley, L. J., Dick, H., et al (1986) Raised plasma Cortisol concentrations a feature of drug-free psychotics and not specific for depression. British Journal of Psychiatry, 148, 58–65.CrossRefGoogle Scholar
DeBold, C. R., Sheldon, W. R., DeCherney, G. S., et al (1984) Arginine vasopressin potentiates adrenocorticotropin release induced by ovine corticotropin-releasing factor. Journal of Clinical Investigation, 73, 533–538.CrossRefGoogle ScholarPubMed
Devanand, D. P., Pandurangi, A. K. & Dewan, M. J. (1984) False-positive dexamethasone suppression test results related to antipsychotic drug withdrawal: case report. Clinical Psychiatry, 45, 275–276.Google Scholar
Dilsaver, S. C. & Greden, J. F. (1984) Effects of antidepressant withdrawal on the dexamethasone suppression test. Psychiatry Research, 14, 111–122.CrossRefGoogle Scholar
Edelstein, C. K., Roy-Byrne, P., Fawzy, F. I., et al (1983) Effects of weight loss on the dexamethasone suppression test. American Journal of Psychiatry, 140, 338–341.Google Scholar
Fichter, M. M. & Pirke, K. M. (1986) Effect of experimental and pathological weight loss upon the hypothalamo–pituitary–adrenal axis. Psychoneuroendocrinology, 11, 295–305.Google Scholar
Gerken, A. & Holsboer, F. (1986) Cortisol and corticosterone response after syn-corticotropin in relationship to dexamethasone suppressibility of Cortisol. Psychoneuroendocrinology, 11, 185–194.Google Scholar
Gibbs, D. M. (1986) Vasopressin and oxytocin: hypothalamic modulators of the stress response: a review. Psychoneuroendocrinology, 11, 131–140.Google Scholar
Gold, P. W., Chrousos, G. P., Kellner, C., et al (1984) Psychiatric implications of basic and clinical studies with corticotropin-releasing factor. American Journal of Psychiatry, 141, 619–627.Google Scholar
Gold, P. W. & Chrousos, G. P., (1985) Clinical studies with corticotropin releasing factor: implications for the diagnosis and pathophysiology of depression, Cushing's disease, and adrenal insufficiency. Psychoneuroendocrinology, 10, 401–419.Google Scholar
Gold, P. W., Loriaux, D. L., Roy, A., et al (1986) Responses to corticotropin-releasing hormone in the hypercortisolism of depression and Cushing's disease. New England Journal of Medicine, 314, 1329–1336.Google Scholar
Gold, P. W., Kling, M. A., Khan, I., et al (1987) Corticotropin releasing hormone: relevance to normal physiology and to the pathophysiology and differential diagnosis of hypercortisolism and adrenal insufficiency. In Hypothalamic Dysfunction in Neuropsychiatric Disorders (eds Nerozzi, D., Goodwin, F. K. & Costa, E.). New York: Raven Press.Google Scholar
Greden, J. F., Flegel, P., Haskett, R., et al (1986) Age effects in serial hypothalamic–pituitary–adrenal monitoring. Psychoneuroendocrinology, 11, 195–204.CrossRefGoogle ScholarPubMed
Hamilton, M. (1960) A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23, 56–72.Google Scholar
Holl, W. R., Fehm, H. L., Voigt, K. H., et al (1986) Acute effects of desipramine and clomipramine on pituitary-adrenal axis in man. Hormone and Metabolism Research, 18, 134–137.Google Scholar
Holsboer, F., Gerken, A., Stalla, G. K., et al (1985a) ACTH, Cortisol, and corticosterone output after ovine corticotropin-releasing factor challenging during depression and after recovery. Biological Psychiatry, 20, 276–286.Google Scholar
Holsboer, F., Gerken, A., Stalla, G. K., et al (1985b) Blunted corticotropin and normal Cortisol response to human corticotropin-releasing factor in depression. New England Journal of Medicine, 311, 1127.Google Scholar
Holsboer, F., Gerken, A., Von Bardeleben, U., et al (1986) Human corticotropin-releasing hormone in depression–correlation with thyrotropin secretion following thyrotropin-releasing hormone. Biological Psychiatry, 21, 601–611.Google Scholar
Jaeckle, R. S., Kathol, R. G., Lopez, J. F., et al (1987) Enhanced adrenal sensitivity to exogenous ACTHalpha 1–24 stimulation in major depression: relationship to dexamethasone suppression test result. Archives of General Psychiatry, 43, 233–240.CrossRefGoogle Scholar
Kathol, R. G. (1985a) Etiologic implications of corticosteroid changes in affective disorder. Psychiatric Medicine, 3, 135–162.Google Scholar
Kathol, R. G. (1985b) Persistent elevation of urinary free Cortisol and loss of circannual periodicity in recovered depressive patients. Journal of Affective Disorders, 8, 137–145.CrossRefGoogle ScholarPubMed
Keitner, G. I., Brown, W. A., Qualls, C. B., et al (1985) Results of the dexamethasone suppression test in psychiatric patients with and without weight loss. American Journal of Psychiatry, 142, 246–247.Google ScholarPubMed
Keller-Wood, M. E. & Dallman, M. F. (1984) Corticosteroid inhibition of ACTH secretion. Endocrine Reviews, 5, 1–24.Google Scholar
Kocsis, J. H., Davis, J. M., Katz, M. M., et al (1985) Depressive behavior and hyperactive adrenocortical function. American Journal of Psychiatry, 142, 1291–1298.Google ScholarPubMed
Kraus, R. P., Hux, M. & Grof, P. (1987) Psychotropic drug withdrawal and the dexamethasone suppression test. American Journal of Psychiatry, 144, 82–85.Google Scholar
Krishnan, K. R. R., France, R. D., Snipes, M. T., et al (1985) Weight change and the dexamethasone suppression test. Biological Psychiatry, 20, 1015–1018.Google Scholar
Lewis, D. A., Pfohl, B., Schlechte, J., et al (1984) Influence of age on the Cortisol response to dexamethasone. Psychiatry Research, 13, 213–220.Google Scholar
Linkowski, P., Mendlewicz, J., Leclercq, R., et al (1985) The 24-hour profile of adrenocorticotropin and Cortisol in major depressive illness. Journal of Clinical Endocrinology and Metabolism, 61, 429–438.Google Scholar
Lopez, J. F., Watson, S., Young, E., et al (1984) CRF releases beta-endorphin/beta-LPH in normal humans. Society of Neuro-science Abstracts, 10, 83.Google Scholar
Lopez, J. F., Kathol, R. G., Jaeckle, R. S., et al (1987) The HPA axis response to insulin hypoglycemia in depression. Biological Psychiatry, 22, 153–166.Google Scholar
Meller, W. H., Kathol, R. G., Jaeckle, R. S., et al (1987) Stimulation of the pituitary-adrenal axis with arginine vasopressin in patients with depression. Psychiatric Research, 21, 269–277.Google Scholar
Mellsop, G. W., Hutton, J. D. & Delahunt, J. W. (1985) Dexamethasone suppression test as a simple measure of stress? British Medical Journal, 290, 1804–1806.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.Google Scholar
Nelson, W. H., Orr, W. W. jr, Shane, S. R., et al (1984) Hypothalamic–pituitary–adrenal axis activity and age in major depression. Clinical Psychiatry, 45, 120–121.Google ScholarPubMed
Nemeroff, C. B., Widerlov, E., Bissette, G., et al (1984) Elevated concentrations of CSF corticotropin-releasing factor-like immunoreactivity in depressed patients. Science, 226, 1342–1344.CrossRefGoogle ScholarPubMed
Oxenkrug, G. F., Pomara, N., McIntyre, I. M., et al (1983) Aging and Cortisol resistance to suppression by dexamethasone: a positive correlation. Psychiatry Research, 10, 125–130.Google Scholar
Pepper, G. M. & Krieger, D. T. (1984) Hypothalamic–pituitary–adrenal abnormalities in depression: their possible relation to central mechanisms regulating ACTH release. In Neurobiology of Mood Disorders (eds Post, R. M. & Ballenger, J. C.). Baltimore: Williams & Wilkins.Google Scholar
Pfohl, B., Sherman, B., Schlechte, J., et al (1985a) Pituitary–adrenal axis rhythm disturbances in psychiatric depression. Archives of General Psychiatry, 42, 897–903.CrossRefGoogle ScholarPubMed
Pfohl, B., Sherman, B., Schlechte, J., et al (1985b) Differences in plasma ACTH and Cortisol between depressed patients and normal controls. Biological Psychiatry, 20, 1055–1072.Google Scholar
Pfohl, B., Coryell, W., Stangl, D. & Zimmerman, M. (1986) Body weight and reported versus measured weight loss as confounders of the dexamethasone suppression test. Biological Psychiatry, 21, 931–938.Google Scholar
Plotsky, P. (1987) Regulation of hypophysiotropic factors mediating ACTH secretion. In The Hypothalamic–Pituitary–Adrenal Axis Revisited: a Symposium in Honor of Dorothy Krieger and Edward Herbert. Annals of the New York Academy of Sciences (eds Ganong, W. F., Dallman, M. F. & Roberts, J. L.). New York: New York Academy of Sciences.Google Scholar
Plotsky, P., Bruhn, T. & Vale, W. (1985) Hypophysiotropic regulation of adrenocorticotropin secretion in response to insulin-induced hypoglycemia. Endocrinology, 117, 323–329.Google Scholar
Privitera, M. R., Greden, J. F., Gardner, R. W., et al (1982) Interference by carbamazepine with the dexamethasone suppression test. Biological Psychiatry, 17, 611–620.Google Scholar
Reisine, T. & Hoffman, A. (1983) Densensitization of corticotropin-releasing factor receptors. Biochemistry and Biophysics Research Communications, 3, 919–925.Google Scholar
Reus, V. I. (1985) Toward an understanding of Cortisol dysregulation in major depression: a review of studies of the dexamethasone suppression test and urinary free-cortisol. Psychiatric Medicine, 3, 1–21.Google Scholar
Rivier, J., Spiess, J., Rivier, C., et al (1982) Solid phase synthesis of amunine (CRF), sauvagine and urotensin I. In Proceedings of the 17th European Peptide Symposium, Peptides 1982 (eds Blaha, K. & Malon, P.). Berlin: Walter de Truyter.Google Scholar
Robins, L., Helzer, J. E., Croughan, J., et al (1981) National Institute of Mental Health Diagnostic Interview Schedule. Archives of General Psychiatry, 38, 381–389.Google Scholar
Rosenbaum, A. H., Schatzberg, A. F., MacLaughlin, A., et al (1984) The dexamethasone suppression test in normal control subjects: comparison of two assays and effect of age. American Journal of Psychiatry, 141, 1550–1555.Google Scholar
Roy, A., Pickar, D., Paul, S., et al (1987) CSF corticotropin-releasing hormone in depressed patients and normal control subjects. American Journal of Psychiatry, 144, 641–645.Google Scholar
Schlesser, M. A., Winokur, G., Sherman, B. M. (1980) Hypothalamic–pituitary–adrenal axis activity in depressive illness. Archives of General Psychiatry, 37, 737–744.CrossRefGoogle ScholarPubMed
Snedecor, G. W. & Cochran, W. G. (1980) Statistical Methods (7th edn). Ames, Iowa: Iowa State University Press.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., et al (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
Vale, W., Spiess, J., Rivier, C., et al (1981) Characterization of a 41 residue ovine hypothalamic peptide that stimulates the secretion of corticotropin and beta endorphin. Science, 213, 1394–1397.Google Scholar
Winer, B. J. (1971) Statistical Principles in Experimental Design. New York: McGraw-Hill.Google Scholar
Winokur, G., Pfohl, B. & Sherman, B. (1985) The relationships of historically defined subtypes of depression to ACTH and Cortisol levels in depression: preliminary study. Biological Psychiatry, 20, 751–757.Google Scholar
Wynn, P. D., Harwood, J. P., Catt, K. J., et al (1985) Regulation of corticotropin-releasing factor (CRF) receptors in the rat pituitary gland: effects of adrenalectomy on CRF receptors and corticotroph responses. Endocrinology, 116, 1653.Google Scholar
Wysham, C., Pfohl, B. & Kathol, R. G. (1986) Arginine vasopressin stimulation and imipramine. Biological Psychiatry, 21, 1351–1355.Google Scholar
Zimmerman, M., Pfohl, B. M. & Coryell, W. H. (1984) Appetite and weight change and the dexamethasone suppression test. Biological Psychiatry, 19, 923–928.Google Scholar
Zimmerman, M., Coryell, W. & Pfohl, B. (1986) The validity of the dexamethasone suppression test as a marker for endogenous depression. Archives of General Psychiatry, 43, 347–355.Google Scholar
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