Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-24T02:49:03.293Z Has data issue: false hasContentIssue false
  • English
  • Français

Postdexamethason intact and multisequentia ACTH in melancholia

Published online by Cambridge University Press:  18 September 2015

M. Maes ,
C. Vandervorst ,
E. Suy ,
M. Martin ,
B. Minner ,
P. Blockx  and
J. Raus
M. Maes*
Affiliation:
Van het Psychiatrisch Centrum, St-Jozef, Munsterbilzen Universitair Ziekenhuis Antwerpen(UZA)
C. Vandervorst
Affiliation:
Dr. Willems Instituut, Diepenbeek
E. Suy
Affiliation:
Van het Psychiatrisch Centrum, St-Jozef, Munsterbilzen
M. Martin
Affiliation:
Universitair Ziekenhuis Antwerpen(UZA)
B. Minner
Affiliation:
Van het Psychiatrisch Centrum, St-Jozef, Munsterbilzen
P. Blockx
Affiliation:
Universitair Ziekenhuis Antwerpen(UZA)
J. Raus
Affiliation:
Dr. Willems Instituut, Diepenbeek
*
Afdeling Psychiatrie, Universitair Ziekenhuis (UZA), Wilrijkstraat 10, 2520 Edegem België
Get access Rights & Permissions [Opens in a new window]

Summary

The dexamethasone suppression test has been carried out in 111 depressed inpatients. Fasting, 8 a.m. plasma levels of Cortisol and adrenocorticotropic hormone (ACTH) were determined before and after administration of 1 mg dexamethasone. In 64 subjects multisequential (1-17,1-24,1-39) ACTH, and in 47 subjects intact (1-39) ACTH has been determined. Patients with melancholia exhibited significantly higher postdexamethasone Cortisol and intact ACTH values as compared with minor and simple major depressives. Severity of illness was significantly and positively related to postdexamethasone intact ACTH - but not to multisequential ACTH. Cortisol nonsuppressors showed higher postdexamethasone (only intact) ACTH values than Cortisol suppressors. Both postdexamethasone ACTH values were significantly and positively related with the postdexamethasone Cortisol values. We have established that Cortisol nonsuppression during melancholia is determined by an augmented escape of ACTH from suppression by dexamethasone. Intact ACTH showed the most significant clinical relevance for depression and Cortisol nonsuppression. In the clinical practice we advize the use of postdexamethasone intact ACTH in stead of plasma Cortisol or multisequential ACTH.

Keywords

depressiondexamethasone suppression testCortisoladrenocorticotropic hormonedepressiedexamethason suppressie testCortisoladrenocorticotroop hormoon
Type
Research Article
Information
Acta Neuropsychiatrica , Volume 3 , Issue 1 , March 1991 , pp. 8 - 13
Copyright
Copyright © Scandinavian College of Neuropsychopharmacology 1991

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

Literatuur

1.Carroll, BJ. Clinical application of neuroendocrine research in depression. In: Van Praag, HM, Lader, MH, Rafaelsen, OJ, Sachar, EJ, red. Handbook of Biological Psychiatry, Part III: Brain Mechanisms and Abnormal Behavior-Genetics and Neuroendocrinology. New York, Marcel Dekker, 1980.Google Scholar
2.Feinberg, M, Carroll, BJ. Biological markers for endogenous depression, effect of age, severity of illness, weight loss and polarity. Arch gen Psychiat 1984; 41:1080–5.CrossRefGoogle ScholarPubMed
3.Maes, M, De Ruyter, M, Hobin, P, Suy, E. The dexamethasone suppression test, the Hamilton Depression Rating Scale and the DSM-III depressive categories. J aff Dis 1986; 10:207–14.CrossRefGoogle ScholarPubMed
4.Maes, MHJ, De Ruyter, M, Suy, E. Prediction of subtype and severity of depression by means of dexamethasone suppression test, L-tryptophan/competing amino acids ratio, and MHPG flow. Biol Psychiat 1987; 22:177–88.CrossRefGoogle ScholarPubMed
5.Kalin, NH, Weiler, SJ, Shelton, SE. Plasma ACTH and Cortisol concentrations before and after dexamethasone. Psychiat Res 1982; 7:87–92.CrossRefGoogle ScholarPubMed
6.Reus, V, Joseph, M, Dallman, M. ACTH levels after the dexamethasone suppression test in depression. N Engl J Med 1982; 306:238–9.Google ScholarPubMed
7.Holsboer, F, Doerr, HG, Gerken, A, Muller, OA, Sippell, WG. Cortisol, 11-deoxycortisol, and ACTH concentrations after dexamethasone in depressed patients and healthy volunteers. Psychiat Res 1984; 17:15–23.CrossRefGoogle Scholar
8.Holsboer, F, Haack, D, Gerken, A, Vecsi, P. Plasma dexamethasone concentration and differential suppression response of Cortisol and corticosterone in depressives and controls. Biol Psychat 1984; 19:281–91.Google ScholarPubMed
9.Maes, M, Minner, B, Suy, E. The influence of dexamethasone levels on the predictive value of the DST for unipolar major depression and the relationships between post-dexamethasone Cortisol and ACTH levels. J aff. Disor 1989; 17:39–46.CrossRefGoogle ScholarPubMed
10.Maes, M, Vandewoude, M, Schotte, C, Maes, L, Martin, M, Blockx, P. A revised interpretation of the postdexamethasone ACTH and Cortisol values in unipolar depressed females. Psychiat Res 1990; 34:107–26.CrossRefGoogle ScholarPubMed
11.Kalin, NH, Dawson, G, Tariot, P, Shelton, S, Barksdale, C, Weiler, S, Thienemann, M. Function of the adrenal cortex in patients with major depression. J aff Dis 1987; 22:117–25.Google ScholarPubMed
12.Risch, SC, Janowsky, DS, Judd, L, Gillin, JC, Mott, MA, Rausch, JL, Huey, L. Multi-endocrine analysis in depression, In: Schatzberg, F, Nemeroff, GB, red. The Hypothalamic-Pituitary-Adrenal-Axis. New York NY: Raven Press, 1988.Google Scholar
13.Amsterdam, JD, Winokur, A, Abelman, E, Lucki, I, Rickeis, K. Cosyntropin (ACTH1 - 24) stimulation test in depressed patients and healthy subjects. Am J Psychiat 1983; 140:907–9.Google Scholar
14.Amsterdam, JD, Maislin, G, Abelman, E, Berwish, N, Winokur, A. Adrenocortical responsiveness to the ACTH stimulation test in depressed patients and healthy volunteers. J aff Dis 1986; 11:265–74.CrossRefGoogle Scholar
15.American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 3 rd ed., Washington DC: APA, 1980.Google Scholar
16.Spitzer, RL, Williams, JBW, Gibbon, M. Structured Clinical Interview for DSM-III Patient Version. Biometrics Research Department, New York State Psychiatric Institute 722 West 168th Street, New York, 10032, 1985.Google Scholar
17.Hamilton, M: A rating scale for depression. J Neurol Neurosurg Psychiat 1960; 23:56–61.CrossRefGoogle ScholarPubMed
18.Dillon, WR, Goldstein, M: Linear Structural Relations (Lisrel), in Multivariate analyses: Methods and Applications. New York: John Wiley and Sons, 1984: 430–9.Google Scholar
19.Nasr, SJ, Rodgers, C, Pandey, G, Altman, EG, Gaviria, FM, Davis, JM: ACTH and the dexamethasone suppression test in depression. Biol Psychiat 1983; 7:1069–73.Google Scholar
20.Roy, A, Gold, P, Pickar, D, Wolkowitz, OM, Chrousos, G, Paul, SM: Pre and post dexamethasone plasma ACTH levels in depressed patients and normal controls. J aff Dis 1986; 10:95–9.CrossRefGoogle ScholarPubMed
21.Maes, M, Vandervorst, C, Suy, E, Minner, B, Raus, J. A multivariate study on the simultaneous urinary free Cortisol, plasma Cortisol, adrenocorticotropic hormone and 6-endorphin escape from suppression by dexamethasone in melancholic patients. Acta psychia scand 1991; in press.Google Scholar
22.Berger, M. Doerr, P, Lund, R, Bronisch, T, von Zerssen, D. Neuroendocrinological and neurophysiological studies in major depressive disorders: are there biological markers for the endogenous subtype? Biol Psychiat 1982; 17:1217–42.Google ScholarPubMed
23.Asnis, GM, Halbreich, U, Ryan, ND, Rabinowicz, H, Puig-Antich, J, Nelson, B, Novacenko, H, Friedman, JH. The relationship of the dexamethasone suppression test (1 mg and 2 mg) to basal Cortisol levels in endogenous depression. Psychoneuroendocrinol 1987; 12:295–301.CrossRefGoogle ScholarPubMed
24.Halbreich, U, Asnis, GM, Shindledecker, R, Zumoff, B, Nathan, RS. Cortisol secretion in endogenous depression. I. Basal plasma levels. Arch gen Psychiat 1985; 42:904–8.CrossRefGoogle ScholarPubMed
25.Stokes, PE, Stoll, PM, Koslow, SH, Maas, JW, Davis, JM, Swann, AC, Robins, E. Pretreatment DST and hypothalamic-pituitary-adreno-cortical function in depressed patients and comparison groups. Arch gen Psychiat 1984; 41:257–67.CrossRefGoogle Scholar
26.Maes, M, Jacobs, M-P, Suy, E, Minner, M, D'Hondt, P, Raus, J. Prediction of the DST results by means of urinary free Cortisol excretion dexamethasone levels, and age. Biol Psychiat 1990; 27:349–57.CrossRefGoogle Scholar
27.Nemeroff, CB, Widerlow, E, Bissette, G, Walleus, H. Karlsson, I, Eklund, K, Kiets, CD, Loosen, PT, Vale, W. Elevated concentrations of CSF corticotropin-releasing factor-like immunoreactivity in depressed patients. Science 1984; 226:1342–4.CrossRefGoogle ScholarPubMed
28.Roy, A, Pickar, D, Paul, S, Doran, A, Chrousos, GP, Gold, PW. CSF corticotropin-releasing hormone in depressed patients and normal subjects. Am J Psychiat 1987; 144:641–5.Google Scholar
29.Britton, KT, Koob, GF. Behavioral effects of corticotropin-re-leasing-factor. In: Schatzberg, AF, Nemeroff, CB, red. The Hypothalamic-Pituitary-Adrenal-Axis. New York NY: Raven Press, 1988.Google Scholar
30.Gold, PW, Whitfield, HJ, Kling, MA, Demitrack, MA, Brandt, HA, Chrousos, GP. The relevance of corticotropin releasing hormone to normal physiology and to pathophysiologic alterations in Hypot-halamic-Pituitary-Adrenal-Axis function. In: Schatzberg, AF, Nemeroff, CB, red. The Hypothalamic-Pituitary-Adrenal Axis New York NY: Raven Press, 1988: 101–14.Google Scholar
31.Holsboer, F, von Bardeleben, U, Heuser, I, Steiger, A. Human corticotropin releasing hormone challenge tests in depression. In: Schatzberg, AF, Nemeroff, CB, red. The Hypothalamic-Pituitary-Adrenal-Axis. New York NY: Raven Press, 1988: 79–100.Google Scholar
32.Kalin, NH, Takahashi, LK. Altered hypothalamic-pituitary-adrenal regulation in animal models of depression. In: Schatzberg, AF, Nemeroff, CB, red. The Hypothalamic-Pituitary-Adrenal-Axis. New York NY: Raven Press, 1988: 67–78.Google Scholar