title: Noradrenergic function and clinical outcome in antidepressant pharmacotherapy.
abstract: Controversy remains regarding the role of noradrenergic systems in determining clinical response to antidepressant pharmacotherapy. Pineal gland production of melatonin can serve as a physiologic index of noradrenergic function. The aim of this study was to examine the effects of antidepressant treatment on 24-hour urinary excretion of the principle metabolite of melatonin, 6-sulfatoxymelatonin in treatment responders and nonresponders. Twenty-four outpatients meeting DSM-III-R criteria for Major Depression received treatment with either fluvoxamine or imipramine for 6 weeks while participating in a placebo-controlled double-blind clinical trial. Twenty-four hour excretion of 6-sulfatoxymelatonin was measured at baseline and at the conclusion of the treatment trial. Changes in urinary excretion of 6-sulfatoxymelatonin distinguished antidepressant responders from nonresponders, with a significant increase observed in the former group and a significant decrease in the latter. The degree of clinical response was correlated with the change in 6-sulfatoxymelatonin excretion. These results suggest that enhanced noradrenergic function may play an important role in determining clinical response to antidepressant pharmacotherapy.
authors.affiliation: Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA.
authors.forename: H L
authors.initials: HL
authors.lastname: Miller
authors.forename: R D
authors.initials: RD
authors.lastname: Ekstrom
authors.forename: G A
authors.initials: GA
authors.lastname: Mason
authors.forename: R B
authors.initials: RB
authors.lastname: Lydiard
authors.forename: R N
authors.initials: RN
authors.lastname: Golden
mesh_terms: D018759:Adrenergic Uptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D000928:Antidepressive Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D003863:Depression / Q000188:drug therapy* / Q000503:physiopathology / Q000652:urine; D016666:Fluvoxamine / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007099:Imipramine / Q000008:administration & dosage / Q000009:adverse effects; D008550:Melatonin / Q000031:analogs & derivatives / Q000378:metabolism* / Q000652:urine; D009638:Norepinephrine / Q000378:metabolism*; D010870:Pineal Gland / Q000187:drug effects* / Q000378:metabolism; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D018759:Adrenergic Uptake Inhibitors; D000928:Antidepressive Agents; D016666:Fluvoxamine; D007099:Imipramine; D008550:Melatonin; D009638:Norepinephrine; D017367:Selective Serotonin Reuptake Inhibitors; C054513:6-sulfatoxymelatonin