The Role of the Hypothalamus-Pituitary-Adrenocortical System in Depression

  • D. von Zerssen
  • M. Berger
  • P. Doerr
  • C. Lauer
  • C. Krieg
  • K.-M. Pirke
Conference paper


An increased activity of the hypothalamus-pituitary-adrenocortical system (HPAS) during episodes of depression has been reported by several investigators since the middle of the 1950s (Bryson and Martin 1954; Board et al. 1957; for review see Mason 1968; Rubin and Mandell 1966). As this phenomenon occurs only in a certain proportion of patients suffering from depression and disappears with clinical recovery (see, e.g., Kathol et al. 1984), it can be regarded as a state marker for some depressions, especially severe psychotic forms of endogenous depression (see Carroll et al. 1980; Rudorfer et al. 1982). Originally, HPAS activation in depression was hypothetically related to nonspecific stress induced by the disorder, e.g., via anxiety, inner tension, or other symptoms that seem to indicate a breakdown of ego defenses. This interpretation was, however, questioned on several grounds and finally rejected by most authorities in the field of psychoneuroendocrinology (e.g., Sachar 1975,1982; Carroll and Mendels 1976; Rubin and Kendler 1977; Rubin and Poland 1984). We will restrict our discussion of the problem to two arguments which we have empirically analyzed to some depth. They are both related to reports in the literature concerning the endogenous subtype of depression (melancholia). In this subtype the hyperactivity of the HPAS was found not only to be more pronounced than in other subtypes of the disorder but also to display melancholia-specific features which cannot be explained as stress phenomena.


Urinary Free Cortisol Dexamethasone Suppression Test Healthy sUbjects Endogenous Depression BioI Psychiatry 
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Copyright information

© Springer-Verlag Berlin Heidelberg 1986

Authors and Affiliations

  • D. von Zerssen
    • 1
  • M. Berger
    • 1
  • P. Doerr
    • 1
  • C. Lauer
    • 1
  • C. Krieg
    • 1
  • K.-M. Pirke
    • 1
  1. 1.Max-Planck-Institut für PsychiatrieMünchen 40Germany

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