Goodwin G M, Muir W J, Seckl J R, Bennie J, Carroll S, Dick H, Fink G
MRC Brain Metabolism Unit, Royal Edinburgh Hospital, UK.
J Affect Disord. 1992 Oct;26(2):73-83. doi: 10.1016/0165-0327(92)90037-7.
The aims of this study were to determine whether the administration of cortisol has a significant effect on mood in patients with depression and whether the effects of cortisol on changes in plasma hormone concentrations are like those of synthetic corticosteroids. Twelve patients had major depression and one each had dysthymic disorder and a depressive adjustment disorder. Five were male and nine were female. All were in-patients. Eight normal subjects, two females and six males, were used as controls. Basal beta-endorphin concentrations were 2- to 3-fold higher in depressed patients than in control subjects, but there were no significant differences between the patient and control groups in the basal (pre-infusion) plasma concentrations of ACTH, cortisol, growth hormone or prolactin. Cortisol, but not saline infusion resulted in a significant improvement in self rated mood. Surprisingly, cortisol infusion at first increased plasma beta-endorphin concentrations. At later times after cortisol infusion, plasma beta-endorphin concentrations decreased as did the plasma concentrations of ACTH and growth hormone; prolactin levels were increased. These results show (i) that cortisol infusion raises mood significantly in major depression, (ii) that plasma beta-endorphin concentration is a potential marker of major depression (iii) that rather than blunting of corticosteroid effects, responses to cortisol may even be enhanced in depressive illness. The unexpected, initial increase in beta-endorphin stimulated by cortisol, suggests that the action of cortisol is not simply one of negative feedback inhibition, but may involve mineralocorticoid, as well as glucocorticoid receptors.
本研究的目的是确定给予皮质醇是否对抑郁症患者的情绪有显著影响，以及皮质醇对血浆激素浓度变化的影响是否与合成皮质类固醇的影响相似。12名患者患有重度抑郁症，1名患有心境恶劣障碍，1名患有抑郁性适应障碍。5名男性，9名女性。均为住院患者。8名正常受试者，2名女性和6名男性，作为对照。抑郁症患者的基础β-内啡肽浓度比对照受试者高2至3倍，但患者组和对照组在促肾上腺皮质激素（ACTH）、皮质醇、生长激素或催乳素的基础（输注前）血浆浓度方面无显著差异。输注皮质醇而非生理盐水可使自评情绪显著改善。令人惊讶的是，输注皮质醇起初会增加血浆β-内啡肽浓度。在输注皮质醇后的后期，血浆β-内啡肽浓度下降，ACTH和生长激素的血浆浓度也下降；催乳素水平升高。这些结果表明：（i）输注皮质醇可显著提高重度抑郁症患者的情绪；（ii）血浆β-内啡肽浓度是重度抑郁症的一个潜在标志物；（iii）在抑郁症中，对皮质醇的反应可能不会减弱皮质类固醇的作用，甚至可能增强。皮质醇刺激引起的β-内啡肽意外的初始增加表明，皮质醇的作用不仅仅是负反馈抑制，还可能涉及盐皮质激素以及糖皮质激素受体。
