Corticosteroid Responses to the Psychotherapy of Reactive Depressions

Abstract

Detailed longitudinal psychiatric and endocrine observations are reported on 6 women receiving psychotherapy for reactive depressions. The authors hypothesized that confrontation of the precipitating loss during psychotherapy would be transiently more painful to the patient than the previous organized depressive equilibrium state. It was therefore predicted that corticosteroid excretion, as an index of emotional distress, would be highest during the period of confrontation of loss. (Psychiatric judgments were made independent of endocrine data.) The hypothesis was supported to the p < 0.005 level for the group of 6 patients. Corticosteroid elevations during periods of confrontation of loss averaged 36% above levels for depressive equilibrium periods. The significance of the findings is discussed in terms of psychoanalytic theories of depressive illness, particularly the concept “primary” or “essential” depressive experience as distinguished from the secondary depressive symptom syndrome. A model for the psychoendocrine “course” of reactive depressions is proposed. Psychosomatic and psychotherapeutic implications are also considered.