Goodyer I M, Park R J, Herbert J
Developmental Psychiatry Section, Department of Psychiatry, University of Cambridge, Cambridge CB2 2AH, UK.
Biol Psychiatry. 2001 Sep 1;50(5):351-7. doi: 10.1016/s0006-3223(01)01120-9.
Psychoendocrine processes may have a role in explaining individual differences in the outcome of major depression in 8-16-year-old school children.
Salivary cortisol and dehydroepiandrosterone (DHEA) levels at 8:00 AM and 8:00 PM, life events, and comorbidity were assessed at presentation, 36, and 72 weeks in 47 (60%) of 78 clinically referred subjects with a first episode of major depression. Comparisons were made between chronic and nonchronic major depression.
Chronic depression was characterized by being older, cortisol hypersecretion at 8:00 PM at all three assessments, increasing depression-dependent life events over the follow-up period, and comorbid obsessive-compulsive disorder (OCD) at presentation and at 36 weeks. Chronicity may be best predicted by increasing depression-dependent events over the 72-week period. Such events are more likely in cases with evening cortisol hypersecretion at entry and persistent OCD. Variations in DHEA levels were not associated with chronicity or increasing life events.
During adolescence, but not childhood, the persistence of major depression may occur through an increase of risk for further and particular types of depression-dependent undesirable life events (personal disappointments and/or dangers to the self), that are more likely in those subjects with persisting cortisol hypersecretion and unresolved comorbid OCD.
心理内分泌过程可能在解释8至16岁学龄儿童重度抑郁症结局的个体差异方面发挥作用。
对78名首次发作重度抑郁症的临床转诊受试者中的47名（60%）进行评估，在就诊时、36周和72周时测量上午8点和晚上8点的唾液皮质醇和脱氢表雄酮（DHEA）水平、生活事件及共病情况。对慢性和非慢性重度抑郁症进行比较。
慢性抑郁症的特征为年龄较大，在所有三次评估中晚上8点时皮质醇分泌过多，随访期间与抑郁症相关的生活事件增加，以及在就诊时和36周时共病强迫症（OCD）。慢性状态可能通过72周期间与抑郁症相关事件的增加来最好地预测。在入院时晚上皮质醇分泌过多且持续存在强迫症的病例中，此类事件更有可能发生。DHEA水平的变化与慢性状态或生活事件增加无关。
在青春期而非儿童期，重度抑郁症的持续存在可能是由于进一步发生特定类型与抑郁症相关的不良生活事件（个人失望和/或对自身的危险）的风险增加所致，在那些持续存在皮质醇分泌过多和未解决的共病强迫症的受试者中更有可能发生。
