Pituitary-adrenal-system regulation and psychopathology during amitriptyline treatment in elderly depressed patients and normal comparison subjects.
OBJECTIVE
This study was done to compare the effects of 6-week treatment with amitriptyline on hypothalamic-pituitary-adrenocortical (HPA) regulation in elderly depressed patients and age-matched comparison subjects.


METHODS
A combined dexamethasone-suppression/CRH-stimulation (dexamethasone/CRH) test was administered before initiation of amitriptyline treatment and at the end of weeks 1, 3, and 6 of treatment. Thirty-nine depressed inpatients, mean age = 69 years, completed the study. Fourteen normal volunteers, mean age = 67 years, served as comparison subjects.


RESULTS
In relation to the comparison subjects, the depressed patients had a profoundly abnormal HPA response, in particular an exaggerated cortisol release in the dexamethasone/CRH test. This abnormality began to disappear after 1 week of treatment with amitriptyline. In contrast, amitriptyline did not affect neuroendocrine regulation in the comparison subjects at any time during the test period.


CONCLUSIONS
The data suggest that amitriptyline affects HPA regulation in hypercortisolemic depression only, and they raise the possibility that normalization of its feedback control is related to the antidepressive effect of amitriptyline.
Max Planck Institute of Psychiatry, Munich, Germany.
I J
IJ
Heuser
U
U
Schweiger
U
U
Gotthardt
J
J
Schmider
C H
CH
Lammers
M
M
Dettling
A
A
Yassouridis
F
F
Holsboer
D000368:Aged; D000639:Amitriptyline / Q000494:pharmacology / Q000627:therapeutic use*; D003346:Corticotropin-Releasing Hormone; D003866:Depressive Disorder / Q000097:blood* / Q000188:drug therapy / Q000503:physiopathology; D003907:Dexamethasone; D005246:Feedback / Q000187:drug effects / Q000502:physiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D010913:Pituitary-Adrenal System / Q000187:drug effects / Q000503:physiopathology; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000639:Amitriptyline; D003907:Dexamethasone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone