Keller Jennifer, Flores Benjamin, Gomez Rowena G, Solvason H Brent, Kenna Heather, Williams Gordon H, Schatzberg Alan F
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California 94305-5723, USA.
Biol Psychiatry. 2006 Aug 1;60(3):275-81. doi: 10.1016/j.biopsych.2005.10.014. Epub 2006 Feb 3.
Increased hypothalamic-pituitary-adrenal axis activity is well described in psychotic depression with an emphasis on 24-hour, urinary free cortisol levels or dexamethasone suppression tests. There are limited data on cortisol levels during specific times of the day.
Patients with depression with (PMD) and without (NPMD) psychosis and healthy control subjects were studied using rating scales of depression and psychosis and measures of HPA activity, including overnight cortisol and adrenocorticotropin levels. We used analysis of variance to determine group differences and regression analyses to assess contributions of specific measures to cortisol levels.
PMDs had higher cortisol during the evening hours than did NPMDs or control subjects, who did not differ from one another. Regression analyses suggest that depression and the combination of depressive and psychotic symptoms were important contributors to variance in evening cortisol.
PMD is associated with increased cortisol levels during the quiescent hours. Enhanced cortisol activity, particularly a higher nadir, was related to depression severity and the interaction of depressive and psychotic symptoms. This increase suggests a defect in the action of the circadian timing system and HPA axis, creating a hormonal milieu similarly seen in early Cushing's syndrome and potentially an (im)balance of mineralocorticoid and glucocorticoid receptor activity.
下丘脑 - 垂体 - 肾上腺轴活性增加在精神病性抑郁症中已有充分描述，重点在于24小时尿游离皮质醇水平或地塞米松抑制试验。关于一天中特定时间的皮质醇水平的数据有限。
对伴有（PMD）和不伴有（NPMD）精神病的抑郁症患者以及健康对照者进行研究，使用抑郁和精神病评定量表以及下丘脑 - 垂体 - 肾上腺轴活性测量指标，包括夜间皮质醇和促肾上腺皮质激素水平。我们使用方差分析来确定组间差异，并使用回归分析来评估特定测量指标对皮质醇水平的贡献。
PMD患者在夜间的皮质醇水平高于NPMD患者或对照者，而NPMD患者和对照者之间无差异。回归分析表明，抑郁以及抑郁和精神病性症状的组合是夜间皮质醇水平变化的重要因素。
PMD与静息时段皮质醇水平升高有关。皮质醇活性增强，尤其是较低的最低点，与抑郁严重程度以及抑郁和精神病性症状的相互作用有关。这种升高表明昼夜节律计时系统和下丘脑 - 垂体 - 肾上腺轴的作用存在缺陷，产生了类似于早期库欣综合征所见的激素环境，并且可能存在盐皮质激素和糖皮质激素受体活性的（不）平衡。
