Nocturnal melatonin and cortisol secretion in newly admitted psychiatric inpatients

Implications for affective disorders
  • Meir Steiner
  • Gregory M. Brown
  • Sue Goldman
Original Articles

Summary

Melatonin secretion has been suggested as a marker of both circadian and noradrenergic dysfunction in affective disorders. Seventy-two newly admitted psychiatric inpatients [49 with major depressive disorder (MDD), 12 with schizophrenia, and 11 with intermittent depressive disorder (IDD)] underwent neuroendocrine screening at 0200, 0800, 1600 and 2300 hours prior to and the day following dexamethasone administration. All groups showed a drop in cortisol following dexamethasone. Dexamethasone nonsuppression was found in 20 of 49 patients with MDD, in none of the schizophrenics and in none of those with intermittent depressive disorder. Mean melatonin levels decreased significantly after the administration of dexamethasone across all four groups. Overall, the schizophrenic group had a significantly greater mean melatonin level than each of other three groups, whereas the three depressive groups did not differ significantly from one another. Only at 2300 hours did both the schizophrenic group and the MDD patients with normal dexamethasone suppression show significantly greater melatonin levels than the MDD patients with dexamethasone nonsuppression or the IDD group. The observed trend for a low circadian melatonin profile in IDD patients with superimposed personality disorders is puzzling.

Key words

Melatonin Cortisol Depression 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Arato M, Grof E, Grof P, Laszlo I, Brown GM (1985) Reproducibility of the overnight melatonin secretion pattern in healthy men. Adv Biosci 53: 277–282Google Scholar
  2. Arendt J, Hampton S, English J, Kwasowski P, Marks V (1982) 24-Hour profiles of melatonin, cortisol, insulin, C-peptide and GIP following a meal and subsequent fasting. Clin Endocrinol 16: 89–95Google Scholar
  3. Arendt J, Bojkowski C, Franey C, Wright J, Marks V (1985) Immunoassay of 6-hydroxymelatonin sulphate in human plasma and urine: abolition of the urinary 24-hour rhythm with Atenolol. J Clin Endocrinol Metab 60: 1166–1173Google Scholar
  4. Armstrong SM, Cassone VM, Chesworth M, Redman J, Short R (1986) Synchronization of mammalian circadian rhythms by melatonin. In: Wurtman RJ, Waldhauser F (eds) Melatonin in humans, Springer, Wien New York, pp 353–366Google Scholar
  5. Axelrod J (1974) The pineal gland: a neurochemical transducer. Science 184: 1341Google Scholar
  6. Beck-Friis J, Von Rosen D, Kjellman BF, Ljunggren JG, Wetterberg L (1984) Melatonin in relation to body measures, sex, age, season and the use of drugs in patients with major affective disorders and healthy subjects. Psychoneuroendocrinology 9: 261–277Google Scholar
  7. Beck-Friis J, Ljunggren J-G, Thoren M, Von Rosen D, Kjellman BF, Wetterberg L (1985a) Melatonin, cortisol and ACTH in patients with major depressive disorder and healthy humans with special reference to the outcome of the dexamethasone suppression test. Psychoneuroendocrinology 10:173–186Google Scholar
  8. Beck-Friis J, Kjellman BF, Aperia B, Unden F, Von Rosen D, Ljunggren J-G, Wetterberg L (1985b) Serum melatonin in relation to clinical variables in patients with major depressive disorder and a hypothesis of a low melatonin syndrome. Acta Psychiatr Scand 71:319–330Google Scholar
  9. Branchey L, Weinberg U, Branchey M, Linkowski P, Mendlewicz J (1982) Simultaneous study of 24-hour patterns of melatonin and cortisol secretion in depressed patients. Neuropsychobiology 8: 225–232Google Scholar
  10. Brown GM, Niles L (1982) Studies on melatonin and other pineal factors. In: Martini L, Besser GM (eds) Clinical neuroendocrinology, vol 2. Academic Press, New York, pp 205–264Google Scholar
  11. Brown GM, Grota LJ, Pulido O, Burns TG, Niles LP, Snieckus V (1983) Application of immunologic techniques to the study of pineal indolealkylamines. Pineal Res Rev 1: 207–246Google Scholar
  12. Brown GM, Kaplan AS, Kennedy S (1989) Neuroendocrine findings in depression, anorexia nervosa and bulimia. In: Lerer B, Gershon S (eds) New directions in affective disorders. Springer, New York Berlin Heidelberg, pp 475–479Google Scholar
  13. Brown R, Kocsis J, Caroff S, Amsterdam J, Winokur A, Stokes P, Frazer A (1985) Differences in nocturnal melatonin secretion between melancholic depressed patients and control subjects. Am J Psychiatry 142: 811–816Google Scholar
  14. Brown RP, Kocsis JH, Caroff S, Amsterdam J, Winokur A, Stokes P, Frazer A (1987) Depressed mood and reality disturbance correlate with decreased nocturnal melatonin in depressed patients. Acta Psychiatr Scand 76: 272–275Google Scholar
  15. Carroll BJ (1982) The Dexamethasone Suppression Test for melancholia. Br J Psychiatry 140: 292–304Google Scholar
  16. Carroll BJ, Feinberg M, Greden JF, Tarika J, Albala A, Haskett RF, James N, Kronfol Z, Lohr N, Steiner M, De Vigne JP, Young E (1981) A specific laboratory test for the diagnosis of melancholia. Standardization, validation and clinical utility. Arch Gen Psychiatry 38: 15–22Google Scholar
  17. Charney DS, Menkes DB, Heninger GR (1981) Receptor sensitivity and the mechanism of action of antidepressant treatment. Arch Gen Psychiatry 38: 1160–1180Google Scholar
  18. Claustrat B, Chazot G, Brun J, Jordan D, Sassolas G (1984) A chronobiological study of melatonin and cortisol secretion in depressed subjects: plasma melatonin, a biochemical marker in major depression. Biol Psychiatry 19: 1215–1228Google Scholar
  19. Claustrat B, Brun J, Garry P, Roussel B, Sassolas G (1986) A once-repeated study of nocturnal plasma melatonin patterns and sleep recordings in six normal young men. J Pineal Res 3: 301–310Google Scholar
  20. Diagnostic and Statistical Manual of Mental Disorders, 3rd edn (1980) APA, Washington, DCGoogle Scholar
  21. Dietzel M (1987) Circadian melatonin pattern in depression: influence of bright-light treatment. Adv Pineal Res 2:231–240Google Scholar
  22. Duncan DB (1955) Multiple range and multipleF tests. Biometrics II: 1–42Google Scholar
  23. Endicott J, Spitzer RL (1978) A diagnostic interview: the schedule for affective disorders and schizophrenia. Arch Gen Psychiatry 35: 837–844Google Scholar
  24. Ettigi PG, Brown GM, Seggie JA (1979) TSH and LH responses in subtypes of depression. Psychosom Med 41: 203–208Google Scholar
  25. Hamilton M (1960) A rating scale for depression. J Neurol Neurosurg Psychiatry 23: 56–61Google Scholar
  26. Hariharasubramanian N, Nair NPV, Pilapil C (1985) Circadian rhythm of plasma melatonin and cortisol during the menstrual cycle. Adv Biosci 53: 31–36Google Scholar
  27. Iguchi H, Kato K, Ibayashi H (1982) Age-dependent reduction in serum melatonin concentrations in healthy human subjects. J Clin Endocrinol Metab 55: 27–29Google Scholar
  28. Illnerova H, Zvolsky P, Vanecek J (1985) The circadian rhythm in plasma melatonin concentration of the urbanized man: the effect of summer and winter time. Brain Res 328: 186–189Google Scholar
  29. Keane PM, Stuart J, Mendez J, Barbadoro SA, Walker WHC (1975) Rapid, specific assay for plasma cortisol by competitive protein binding. Clin Chem 21: 1474–1478Google Scholar
  30. Kennaway DJ, Royles P (1986) Circadian rhythms of 6-sulphatoxy melatonin, cortisol and electrolyte excretion at the summer and winter solstices in normal men and women. Acta Endocrinol (Copenh) 113: 450–456Google Scholar
  31. Kennedy SH, Garfinkel PE, Parienti V, Costa D, Brown GM (1989) Changes in melatonin levels but not cortisol levels are associated with depression in patients with eating disorders. Arch Gen Psychiatry 46: 73–78Google Scholar
  32. Kirk RE (1982) Experimental design: procedures for the behavioural sciences, 2nd edn. Brooks/Cole, BelmontGoogle Scholar
  33. Kramer CY (1956) Extension of multiple range test to group means with unequal numbers of replications. Biometrics 12: 307–310Google Scholar
  34. Kripke DF, Mullaney DJ, Gabriel S (1986) The chronopharmacology of antidepressant drugs. Annu Rev Chronopharmacol 2: 275–289Google Scholar
  35. Lang U, Theintz G, Rivest RW, Sizonenko PC (1986) Nocturnal urinary melatonin excretion and plasma cortisol levels in children and adolescents after a single oral dose of dexamethasone. Clin Endocrinol 25: 165–172Google Scholar
  36. Lynch HJ, Brzezinski A, Deng MH, Lieberman HR, Wurtman RJ (1987) Effect of behavioural and physiological variables on melatonin secretion in humans. Adv Pineal Res 4: 181–190Google Scholar
  37. Mendlewicz J, Linkowski P, Branchey L, Weinberg U, Weitzman ED, Branchey M (1979) Abnormal 24-hour pattern of melatonin secretion in depression (letter). Lancet ii: 1362Google Scholar
  38. Murphy DL, Tamarkin L, Sunderland T, Garrick NA, Cohen RM (1986) Human plasma melatonin is elevated during treatment with the monoamine oxidase inhibitors clorgyline and tranylcypromine but not deprenyl. Psychiatry Res 17: 119–127Google Scholar
  39. Nair NPV, Hariharasubramanian N, Pilapil C (1985) Circadian rhythm of plasma melatonin and cortisol in endogenous depression. Adv Biosci 53: 339–345Google Scholar
  40. Nair NPV, Hariharasubramanian N, Pilapil C, Isaac I, Thavundayil JX (1986) Plasma melatonin — an index of brain aging in humans? Biol Psychiatry 21: 141–150Google Scholar
  41. Nair NPV, Sharma M, Ghadirian A, Thakur M, Quirion R (1988) Effect of antidepressant treatment on the circadian rhythms of cortisol and melatonin. Abstract no TH-55, 11th Annual Scientific Meeting of the Canadian College of Neuropsychopharmacology, Montreal, Quebec. Pfizer Medical Services. CanadaGoogle Scholar
  42. Neter J, Wasserman W, Kutner MH (1985) Applied linear statistical models: Regression, analysis of variance, and experimental designs, 2nd edn. Irwin, Homeword, Ill.Google Scholar
  43. Niles LP, Brown GM, Grota LJ (1977) Endocrine effects of the pineal gland and neutralization of circulating melatonin and N-acetylserotonin. Can J Physiol Pharmacol 55: 537–544Google Scholar
  44. Preslock J (1984) The pineal gland: basic implications and clinical correlations. Endocr Rev 5: 282–308Google Scholar
  45. Reiter RJ (1987) The melatonin message: duration versus coincidence hypotheses. Life Sci 40: 2119–2131Google Scholar
  46. Sack RL, Lewy AJ (1986) Desmethylimipramine treatment increases melatonin production in humans. Biol Psychiatry 21: 406–410Google Scholar
  47. Sack RL, Lewy AJ, Erb DL, Vollmer WM, Singer CM (1986) Human melatonin production decreases with age. J Pineal Res 3: 379–388Google Scholar
  48. Seggie J (1985) Comparison of adrenal and pineal stress responses. Adv Biosci 53: 295–300Google Scholar
  49. Sharma M, Palacios-Bois J, Schwartz G, Iskandar H, Thakur M, Quirion R, Nair NPV (1989) Circadian rhythms of melatonin and cortisol in aging. Biol Psychiatry 25: 305–319Google Scholar
  50. Siever LJ, Davis KL (1985) Overview: toward a dysregulation hypothesis of depression. Am J Psychiatry 142: 1017–1031Google Scholar
  51. Souêtre E, Salvati E, Savelli M, Krebs B, Jorlet A, Ardisson JL, Darcourt G (1988) Endocrine circadian rhythms in depression and remission. Psychiatry Psychobiol 3: 19–27Google Scholar
  52. Spitzer RF, Endicott J, Robins E (1978) Research diagnostic criteria. Rationale and reliability. Arch Gen Psychiatry 35: 773–782Google Scholar
  53. Steiner M, Werstiuk ES, Seggie J (1987) Dysregulation of neuroendocrine crossroads: depression, circadian rhythms and the retina — a hypothesis. Prog Neuropsychopharmacol Biol Psychiatry 11: 267–278Google Scholar
  54. Thompson C, Mezey G, Corn T, Franey C, English J, Arendt J, Checkley SA (1985) The effect of desipramine upon melatonin and cortisol secretion in depressed and normal subjects. Br J Psychiatry 147: 389–393Google Scholar
  55. Touitou Y, Fevre M, Bogdan A, Reinberg A, De Prins J, Beck H, Touitou C (1984) Patterns of plasma melatonin with aging and mental condition: stability of nyctohemeral rhythms and differences in seasonal variations. Acta Endocrinol (Copenh) 106: 145–151Google Scholar
  56. Wehr TA, Wirz-Justice A (1982) Circadian rhythm mechanisms in affective illness and in antidepressant drug action. Pharmacopsychiatry 15: 31–39Google Scholar
  57. Wirz-Justice A, Arendt J (1979) Diurnal, menstrual cycle and seasonal indole rhythms in man and their modification in affective disorders. In: Obiols J, Ballus C, Gonzales-Monclus E, Pujol J (eds) Biological psychiatry today. Elsevier/North Holland, Amsterdam, pp 294–302Google Scholar
  58. Wirz-Justice A, Richter R (1979) Seasonality in biochemical determinations: a source of variance and a clue to the temporal incidence of affective illness. Psychiatry Res 1: 53–60Google Scholar

Copyright information

© Springer-Verlag 1990

Authors and Affiliations

  • Meir Steiner
    • 1
    • 2
    • 3
  • Gregory M. Brown
    • 1
    • 2
  • Sue Goldman
    • 3
  1. 1.Department of PsychiatryMcMaster UniversityHamiltonCanada
  2. 2.Department of Biomedical SciencesMcMaster UniversityHamiltonCanada
  3. 3.Clinical Studies Program, McMaster Psychiatric UnitSt. Joseph's HospitalHamiltonCanada

Personalised recommendations