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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

Abstract

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.

Keywords

Urinary Free Cortisol Dexamethasone Suppression Test Healthy sUbjects Endogenous Depression BioI Psychiatry 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders, 3rd edn (DSM-III). APA, Washington D.C..Google Scholar
  2. Aschoff J (1980) Wie gestört ist der circadiane Rhythmus bei Depressiven? In: Heimann H, Giedke H (Hrsg) Neue Perspektiven in der Depressionsforschung. Huber, Bern Stuttgart Wien, pp 88–99.Google Scholar
  3. Baumgartner A, Gräf K-J, Kürten I (1985) The dexamethasone suppression test in depression, in schizophrenia and during experimental stress. Biol Psychiatry 20:675–679.PubMedCrossRefGoogle Scholar
  4. Berger M, Klein HE (1984) Der Dexamethason-Suppressions-Test: ein biologischer Marker der endogenen Depression? Eur Arch Psychiatr Neurol Sci 234:137–146.CrossRefGoogle Scholar
  5. Berger M, Doerr P, Lund R, Bronisch T, von Zerssen D (1982) Neuroendocrinological and neurophysiological studies in major depressive disorders: are there biological markers for the endogenous subtype? Biol Psychiatry 17:1217–1242.PubMedGoogle Scholar
  6. Berger M, Pirke KM, Doerr P, Krieg C, von Zerssen D (1983) Influence of weight loss on the dexamethasone suppression test. Arch Gen Psychiatry 40:585–586.PubMedGoogle Scholar
  7. Berger M, Pirke KM, Doerr P, Krieg C, von Zerssen D (1984a) The limited utility of the dexamethasone suppression test for the diagnostic process in psychiatry. Brit J Psychiatry 145:372–382.CrossRefGoogle Scholar
  8. Berger M, Wittchen H-U, von Zerssen D (1984b) Versuche der Typisierung von Subgruppen depressiver Erkrankungen anhand multivariater statistischer Analysen von Selbst-und Fremdbeurteilungsskalen sowie operationaler Diagnosekriterien. In: Wolfersdorf M, Staub R, Hole G (Hrsg) Depressive Kranke in der Psychiatrischen Klinik. Roderer, Regensburg, pp 390–402.Google Scholar
  9. Berger M, Pirke KM, Krieg C, von Zerssen D (1985) The effect of weight loss and inappropriate plasma dexamethasone levels on the DST. Psychiatry Res 15:351–360.PubMedCrossRefGoogle Scholar
  10. Board F, Wadeson R, Persky H (1957) Depressive affect and endocrine functions. Arch Neurol Psychiatry 78:612–620.Google Scholar
  11. Brown WA (1984) Use of the dexamethasone suppression test in depression. In: Post RM, Ballenger JC (eds) Neurobiology of mood disorders. Williams & Wilkins, Baltimore London, pp 290–296.Google Scholar
  12. Bryson RW, Martin DF (1954) 17-Ketosteroid excretion in a case of manic-depressive psychosis. Lancet II:365–367.CrossRefGoogle Scholar
  13. Carney MWP, Roth M, Garside RF (1965) The diagnosis of depressive syndromes and the prediction of E.C.T. response. Br J Psychiatry 111:659–674.PubMedCrossRefGoogle Scholar
  14. Carroll BJ (1982) The dexamethasone suppression test for melancholia. Br J Psychiatry 140:292–304.PubMedCrossRefGoogle Scholar
  15. Carroll BJ (1984) Dexamethasone suppression test. In: Hall RCW, Beresford TP (eds) Handbook of psychiatric diagnostic procedures, vol I. MTP Press Limited, Lancaster, pp 3–28.Google Scholar
  16. Carroll BJ, Mendels J (1976) Neuroendocrine regulation in affective disorders. In: Sachar EJ (ed) Hormones, behavior, and psychopathology. Raven, New York, pp 193–224.Google Scholar
  17. Carroll BJ, Curtis GC, Mendels J (1976) Neuroendocrine regulation in depression. I. Limbic system-adrenocortical dysfunction. Arch Gen Psychiatry 33:1039–1044.PubMedGoogle Scholar
  18. Carroll BJ, Greden JF, Feinberg M, James NM, Haskett RF, Steiner M, Tarika J (1980) Neuroendocrine dysfunction in genetic subtypes of primary unipolar depression. Psychiatry Res 2:251–258.PubMedCrossRefGoogle Scholar
  19. Ceulemans DLS, Westenberg HGM, van Praag HM (1985) The effect of stress on the dexamethasone suppression test. Psychiatry Res 14:189–195.PubMedCrossRefGoogle Scholar
  20. Coryell W (1984) The use of laboratory tests in psychiatric diagnosis: the DST as an example. Psychiatry Develop 3:139–159.Google Scholar
  21. Doerr P, von Zerssen D (1983) Die zirkadiane Ausscheidung an freiem Harncortisol während der depressiven Phase und im freien Intervall bei Patienten mit einer endogenen Depression. In: Faust V, Hole G (eds) Depressionen: Symptomatik-Ätiopathogenese-Therapie. Hippokrates, Stuttgart, pp 142–150.Google Scholar
  22. Enright JT (1981) Data analysis. In: Aschoff J (ed) Biological rhythms. Handbook of behavioral neurobiology, vol 4. Plenum, New York London, pp 21–39.Google Scholar
  23. Green HS, Kane JM (1983) The dexamethasone suppression test in depression. Clin Neuropharmacol 6:7–24.PubMedCrossRefGoogle Scholar
  24. Henry JP, Stephens PM (1977) Stress, health, and the social environment. Springer, New York Heidelberg Berlin.CrossRefGoogle Scholar
  25. Hirschfeld RMA, Koslow SH, Kupfer DJ (1983) The clinical utility of the dexamethasone suppression test in psychiatry. J Am Med Ass 250:2172–2174.CrossRefGoogle Scholar
  26. Holsboer F (1984) Prediction of clinical course by dexamethasone suppression test (DST) response in depressed patients — physiological and clinical construct validity of the DST. Pharmacopsychiatry 16:186–191.CrossRefGoogle Scholar
  27. Jarrett DB, Coble PA, Kupfer DJ (1983) Reduced cortisol latency in depressive illness. Arch Gen Psychiatry 40:506–511.PubMedGoogle Scholar
  28. Johnson GF, Hunt G, Kerr K, Caterson I (1984) Dexamethasone suppression test (DST) and plasma dexamethasone levels in depressed patients. Psychiatry Res 13:305–313.PubMedCrossRefGoogle Scholar
  29. Jones MT, Gillham B, Di Renzo G, Beckford U, Holmes MC (1981) Neural control of corticotrophin secretion. In: van Wimersma Greidanus TB, Rees LH} (eds) Frontiers of hormone research, vol 8, ACTH and LPH in health and disease. Karger, Basel, pp 12–43.Google Scholar
  30. Kalin NH, Cohen RM, Kraemer GW, Risch SC, Shelton S, Cohen M, McKinney WT, Murphy DL (1981) The dexamethasone suppression test as a measure of hypothalamic-pituitary feedback sensitivity and its relationship to behavioral arousal. Neuroendocrinology 32:92–95.PubMedCrossRefGoogle Scholar
  31. Kathol RG, Winokur G, Sherman BM, Lewis D, Schlesser M (1984) Provocative endocrine testing in recovered depressives. Psychoneuroendocrinology 9:57–67.PubMedCrossRefGoogle Scholar
  32. Köbberling J, von zur Mühlen A (1972) Methodische Untersuchungen zur Bestimmung der freien Harn-Corticoide mit der Proteinbindungsmethode. Z Klin Chem 10:495–501.Google Scholar
  33. Livingston R, Reis CJ, Ringdahl IC (1984) Abnormal dexamethasone suppression test results in depressed and nondepressed children. Am J Psychiatry 141:106–108.PubMedGoogle Scholar
  34. Lund R, Kammerloher A, Dirlich G (1983) Body temperature in endogenously depressed patients during depression and remission. In: Wehr TA, Goodwin FK (eds) Circadian rhythms in psychiatry. Boxwood, Pacific Grove, pp 77–88.Google Scholar
  35. Mason JW (1968) A review of psychoendocrine research on the pituitary-adrenal cortical system. Psychosom Med 30:576–607.PubMedGoogle Scholar
  36. Mason JW, Sachar EJ, Fishman JR, Hamburg DA, Handion JH (1965) Corticosteroid responses to hospital admission. Arch Gen Psychiatry 13:1–8.PubMedGoogle Scholar
  37. Otnes RK, Enochson L (1978) Applied time series analysis, vol 1, Basic techniques. Wiley & Sons, New York Chichester Brisbane Toronto.Google Scholar
  38. Pfohl B, Sherman B, Schlechte J, Stone R (1985) Pituitary-adrenal axis rhythm disturbances in psychiatric depression. Arch Gen Psychiatry 42:897–903.PubMedGoogle Scholar
  39. Rubin RT, Kendler KS (1977) Psychoneuroendocrinology: fundamental concepts and correlates in depression. In: Usdin G (ed) Depression: clinical, biological, and psychological perspectives. Brunner & Mazel, New York, pp 122–138.Google Scholar
  40. Rubin RT, Mandell AJ (1966) Adrenal cortical activity in pathological emotional states: a review. Am J Psychiatry 123:387–400.PubMedGoogle Scholar
  41. Rubin RT, Poland RE (1982) The chronoendocrinology of endogenous depression. In: Müller EE, MacLeod RM (eds) Neuroendocrine perspectives, vol 1. Elsevier Biomedicai, Amsterdam New York Oxford, pp 305–337.Google Scholar
  42. Rubin RT, Poland RE (1984) Pituitary-adrenocortical and pituitary-gonadal function in affective disorder. In: Brown GM, Koslow SH, Reichlin S (eds) Neuroendocrinology and psychiatric disorder. Raven, New York, pp 151–164.Google Scholar
  43. Rudorfer MV, Hwu H-G, Clayton PJ (1982) Dexamethasone suppression test in primary depression: significance of family history and psychosis. Biol Psychiatry 17:41–48.PubMedGoogle Scholar
  44. Sachar EJ (1975) Neuroendocrine abnormalities in depressive illness. In: Sachar EJ (ed) Topics in psychoendocrinology. Grune & Stratton, New York, pp 135–156.Google Scholar
  45. Sachar EJ (1982) Endocrine abnormalities in depression. In: Paykel ES (ed) Handbook of affective disorders. Churchill Livingstone, Edinburgh, pp 191–201.Google Scholar
  46. Sachar EJ, Hellman L, Roffwarg HP, Halpern FS, Fukushima DK, Gallagher TF (1973) Disrupted 24-hour patterns of coritisol secretion in psychotic depression. Arch Gen Psychiatry 28:19–24.PubMedGoogle Scholar
  47. Sakai M (1960) Diurnal rhythm of 17-ketosteroid and diurnal fluctuation of depressive affect. Yokohama Med Bull 11:352–367.PubMedGoogle Scholar
  48. Schulz H, Lund R (1985) On the origin of early REM episodes in the sleep of depressed patients. Comparison of three hypotheses. Psychiatry Res 16:654–77.CrossRefGoogle Scholar
  49. Spitzer RL, Endicott JE, Robins E (1978) Research Diagnostic Criteria. Arch Gen Psychiatry 35:773–782.PubMedGoogle Scholar
  50. Stokes PE, Stoll PM, Koslow SH, Maas JW, Davis JM, Swann AC, Robins E (1984) Pretreatment DST and hypothalamic-pituitary-adrenocortical function in depressed patients and comparison groups. Arch Gen Psychiatry 41:257–267.PubMedGoogle Scholar
  51. Wehr TA, Goodwin FK (1981) Biological rhythms and psychiatry. In: Arieti S (ed) American handbook of psychiatry: advances and new directions, 2nd ed. Basic, New York, pp 46–74.Google Scholar
  52. Wehr TA, Goodwin FK (1983) Biological rhythms in manic-depressive illness. In: Wehr TA, Goodwin FK (eds) Circadian rhythms in psychiatry. Boxwood, Pacific Grove, pp 129–184.Google Scholar
  53. Wittchen H-U, Semler G, von Zerssen D (1985) A comparison of two diagnostic methods. Clinical ICD diagnoses vs DSM-III and Research Diagnostic Criteria using the Diagnostic Interview Schedule (version 2). Arch Gen Psychiatry 42:677–684.PubMedGoogle Scholar
  54. Yamashita I, Moroji T, Yamazaki K, Kato H, Sakahita A, Onodera I, Ito K, Okada S, Sarto Y, Tomakushi M, Suwa N (1969) Neuroendocrinological studies in mental disorders and psychotropic drugs: Part I, On the circadian rhythm of the plasma adrenocortical hormone in mental patients and methamphetamine-and chlorpromazine-treated animals. Folia Psychiat Neurol Jap 23:143–158.PubMedGoogle Scholar
  55. Zerssen von D (1983) Chronobiology of depression. In: Angst J (ed) The origins of depression: current concepts and approaches. Springer, Berlin Heidelberg New York Tokyo, pp 253–271 (Dahlem Konferenzen).Google Scholar
  56. Zerssen von D (1986) Clinical self-rating scales (CSRS) of the Munich psychiatric information system (PSYCHIS München). In: Sartorius N, Ban TA (eds) Assessment of depression. Springer, Berlin Heidelberg New York Tokyo, pp 270–303.Google Scholar
  57. Zerssen von D, Doerr P (1980) The role of the hypothalamo-pituitary-adrenocortical system in psychiatric disorders. Advanc Biol Psychiatry 5:85–106.Google Scholar
  58. Zerssen von D, Koeller D-M (1976) Klinische Selbstbeurteilungs-Skalen aus dem Münchener Psychiatrischen Informations-System (PSYCHIS München) Klinische Selbstbeurteilungs-Skalen aus dem Münchener Psychiatrischen Informations-System (PSYCHIS München). Manuale: a) Allgemeiner Teil; b) Die Beschwerden-Liste; c) Paranoid-Depressivitäts-Skala, Depressivitäts-Skala; d) Die Befindlichkeits-Skala. Beltz Test, Weinheim.Google Scholar
  59. Zerssen von D, Berger M, Doerr P (1984) Neuroendocrine dysfunction in subtypes of depression. In: Shah NS, Donald AG (eds) Psychoneuroendocrine dysfunction. Plenum, New York, pp 357–382.Google Scholar
  60. Zerssen von D, Barthelmes H, Dirlich G, Doerr P, Emrich HM, Lindern von L, Lund R, Pirke KM (1985) Circadian rhythms in endogenous depression. Psychiatry Res 16:51–63.Google Scholar
  61. Zimmerman M, Coryell W, Pfohl B, Stangl D (1985) Four definitions of endogenous depression and the dexamethasone suppression test, J Aff Disorders 8:37–45.CrossRefGoogle Scholar

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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