title: Mineralocorticoid receptor function in major depression.
abstract: BACKGROUND
  Negative feedback regulation of the hypothalamic-pituitary-adrenal axis occurs through a dual-receptor system of mineralocorticoid receptors (MR) and glucocorticoid receptors (GR). Their affinity for cortisol and their distribution in the brain differ. Studies using an MR antagonist have demonstrated that MR is active throughout the circadian rhythm. Because major depression is accompanied by increased glucocorticoid secretion and insensitivity to glucocorticoid feedback, and because glucocorticoids are capable of down-regulating MR and GR, we expected that major depression would be accompanied by decreased MR activity.
  
  
  METHODS
  To test this hypothesis, we administered spironolactone, an MR antagonist, to individuals with major depression and matched control subjects and assessed levels of corticotropin and cortisol secretion in response to this acute challenge. Studies were conducted in the morning, the time of peak activation of the hypothalamic-pituitary-adrenal axis. All patients were currently depressed and free of all medications. All controls were free of all psychiatric diagnoses and of all medications.
  
  
  RESULTS
  Spironolactone treatment resulted in a significant increase in cortisol secretion levels in both groups. Depressed patients demonstrated higher cortisol secretion levels than control subjects. In addition, depressed patients demonstrated a different pattern of increase in cortisol secretion levels after spironolactone administration. Furthermore, a significant effect of spironolactone treatment on corticotropin secretion levels can be observed in depressed patients, whereas controls show no such effect.
  
  
  CONCLUSIONS
  Despite high baseline cortisol levels, patients with major depression show high functional activity of the MR system. Paired with the body of evidence regarding decreased sensitivity to GR agonists, these data suggest an imbalance in the MR/GR ratio. The balance of MR and GR is known to affect brain serotonin systems and may play an etiologic role in serotonin receptor changes observed in patients with major depression.
authors.affiliation: Mental Health Research Institute and Department of Psychiatry, University of Michigan, 205 Zina Pitcher Pl, Ann Arbor, MI 48109-0720, USA. eayoung@umich.edu
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Young
authors.forename: Juan F
authors.initials: JF
authors.lastname: Lopez
authors.forename: Virginia
authors.initials: V
authors.lastname: Murphy-Weinberg
authors.forename: Stanley J
authors.initials: SJ
authors.lastname: Watson
authors.forename: Huda
authors.initials: H
authors.lastname: Akil
mesh_terms: D000328:Adult; D002940:Circadian Rhythm / Q000502:physiology; D003866:Depressive Disorder / Q000097:blood / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects / Q000502:physiology; D008297:Male; D000451:Mineralocorticoid Receptor Antagonists / Q000494:pharmacology; D010913:Pituitary-Adrenal System / Q000187:drug effects / Q000502:physiology; D011965:Receptors, Glucocorticoid / Q000187:drug effects / Q000502:physiology; D018161:Receptors, Mineralocorticoid / Q000187:drug effects / Q000502:physiology*; D011985:Receptors, Serotonin / Q000502:physiology; D013148:Spironolactone / Q000494:pharmacology
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D011965:Receptors, Glucocorticoid; D018161:Receptors, Mineralocorticoid; D011985:Receptors, Serotonin; D013148:Spironolactone; D006854:Hydrocortisone