Patterns of depression reflected in pituitary - thyroid and pituitary - adrenal endocrine changes

Abstract

In 76 patients with an RDC diagnosis of major depressive disorder, serum TSH, the TSH response to TRH and urinary cortisol excretion were measured. In 51 of these patients, plasma cortisol before and after oral dexamethasone also was analysed. These endocrine measures were uni- and multivariately correlated with subdiagnostic, descriptive and symptomatic variables, largely scored from the Schedule for Affective Disorders and Schizophrenia (SADS) that was used for evaluation of each patient. TSH increase in the TRH test correlated strongly with the ‘primary’/‘secondary’ distinction of major depression (low δTSH—primary diagnosis) and with body height (low δTSH—tall stature). δTSH also displayed a significant negative correlation with urinary free cortisol (UFC). UFC was highly significantly correlated with lower anger scores and with less suicide proneness. Poor suppression of plasma cortisol after oral dexamethasone correlated univariately with more melancholic traits, and multivariately with affective heredity, weight loss and altered motor activity. High concentrations of both 3-methoxy-4-hydroxyphenyl glycol (MHPG) and 5-hydroxyindoleacetic acid (5HIAA) in the cerebrospinal fluid (CSF) correlated with cortisol non-suppression by dexamethasone at 1100 hr during depression. The results indicate that these psychoendocrine measures may show good correlations with a few depressive symptoms and somatic characteristics as well as with selected affective subdiagnoses.