Longitudinal neuroendocrine changes assessed by dexamethasone/CRH and growth hormone releasing hormone tests in psychotic depression.
Although psychotic depression has been reported to exhibit a greater degree of dysregulation of hypothalamic-pituitary-adrenocortical (HPA) function than non-psychotic depression, little is known concerning hypothalamic-pituitary-somatotropic (HPS) function in psychotic depression and how neuroendocrine function changes after treatment. To investigate the longitudinal changes in HPA and HPS system function in psychotic depression, we performed repeated dexamethasone/corticotropin releasing hormone (DEX/CRH) tests and growth hormone (GH) releasing hormone (GHRH) tests in inpatients with major depressive disorder. The psychotic depression group exhibited greater elevation of ACTH responses to the DEX/CRH test and stronger decreases in GH responses to the GHRH test than the non-psychotic depression group at admission. At discharge, the neuroendocrine responses to the DEX/CRH test of the psychotic depression group were still stronger than those of the non-psychotic depression group, though there were no significant differences in severity of depression between the groups. There were significant longitudinal changes in neuroendocrine responses to the DEX/CRH test between admission and discharge. The psychotic depression group exhibited increased GH responses to GHRH at discharge compared with those at admission, whereas no significant longitudinal change in GH response was found in the non-psychotic depression group. Consequently, there were no significant differences in GH responses to GHRH between the psychotic and non-psychotic depression groups at discharge. The results of GHRH test showed no significant relationships with severity of depression except psychotic features and the results of the DEX/CRH test. Our findings suggest that the HPS axis may be associated with psychotic features rather than general severity of depression. Further longitudinal studies are needed to clarify the role of HPS function in psychotic depression and whether sustained dysregulation of HPA function in psychotic depression is associated with a poor outcome after discharge.
Owashi
Toshimi
T
Department of Psychiatry, Showa University School of Medicine, 6-11-11 Kita-karasuyama, Setagaya-ku, Tokyo 157-8577, Japan. owashi-psy@umin.ac.jp
Otsubo
Tempei
T
Oshima
Akihiko
A
Nakagome
Kazuyuki
K
Higuchi
Teruhiko
T
Kamijima
Kunitoshi
K
D000324:Adrenocorticotropic Hormone / Q000097:blood* / Q000378:metabolism; D000328:Adult; D000367:Age Factors; D000368:Aged; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D019540:Area Under Curve; D016022:Case-Control Studies; D003346:Corticotropin-Releasing Hormone; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000097:blood* / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D003907:Dexamethasone; D005260:Female; D005500:Follow-Up Studies; D013006:Growth Hormone / Q000097:blood* / Q000378:metabolism; D013007:Growth Hormone-Releasing Hormone; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000187:drug effects / Q000378:metabolism / Q000503:physiopathology; D011618:Psychotic Disorders / Q000097:blood* / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D012016:Reference Values; D012720:Severity of Illness Index; D012737:Sex Factors; D052683:Somatotrophs / Q000378:metabolism; D018709:Statistics, Nonparametric; D013268:Stimulation, Chemical
D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D013006:Growth Hormone; D003346:Corticotropin-Releasing Hormone; D013007:Growth Hormone-Releasing Hormone