Hormonal differences between psychotic and non-psychotic melancholic depression.
BACKGROUND
The dexamethasone suppression test (DST) is the main hormonal disturbance in psychotic depression compared to non-psychotic depression. However, although there have been many studies of individual hormonal axes in depression, few multi-axial studies have been reported. This study aims to examine hormonal differences between these groups of patients through three functional hormonal tests: DST, thyroid stimulating hormone response to thyroid releasing hormone (TSH-TRF) and growth hormone response to growth hormone releasing factor (GH-GRF).


METHODS
Forty inpatients meeting DSM-III-R criteria for major depressive episode with melancholia (21 non-psychotic and 19 psychotic) were studied. Dexamethasone suppression test, TSH-TRF and GH-GRF tests were undertaken for all patients.


RESULTS
In the whole melancholic sample, 80.0% showed disturbances in at least one hormonal axis, 40.0% in two axes and 5.0% in all three axes. Basal and post-dexamethasone cortisol levels were significantly higher in psychotic than in non-psychotic patients. An association between post-dexamethasone cortisol and blunted GH-GRF response was demonstrated in those with psychotic depression. In the whole sample, GH blunting was found in 62.5% of patients, DST non-suppression in 37.5% and TSH blunting in 25.0% (no differences were found between psychotic and non-psychotic patients).


CONCLUSIONS
Sample was restricted to melancholia and unknown factors may influence hormonal responses to stress.


CONCLUSIONS
Hormonal disturbances in depression are more evident when studying several axes, being the HPA and the GH axes the most prominents. Psychotic depression showed more HPA disturbance than non-psychotic depression. Influence of the HPA on the GH axis is discussed.
Contreras
Fernando
F
Department of Psychiatry, Hospital de Bellvitge, School of Medicine, Barcelona, Spain. fcontreras@csub.scs.es
Menchon
Jose M
JM
Urretavizcaya
Mikel
M
Navarro
Miguel A
MA
Vallejo
Julio
J
Parker
Gordon
G
D003866:Depressive Disorder / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology; D003907:Dexamethasone; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005938:Glucocorticoids; D019382:Human Growth Hormone / Q000097:blood*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000378:metabolism / Q000503:physiopathology; D011618:Psychotic Disorders / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology; D013972:Thyrotropin / Q000097:blood*
D005938:Glucocorticoids; D019382:Human Growth Hormone; D003907:Dexamethasone; D013972:Thyrotropin; D006854:Hydrocortisone