Stein M B, Uhde T W
Biological Psychiatry Branch, National Institute of Mental Health, Bethesda, MD 20892.
Biol Psychiatry. 1988 Jul;24(3):322-30. doi: 10.1016/0006-3223(88)90201-6.
Abnormalities in regulation of noradrenergic function have been proposed as part of the pathology of depressive and panic anxiety disorders. However, abnormalities in hypothalamic-pituitary-adrenal (HPA) axis function have largely been limited to patients with depressive disorders. Using the cortisol response to clonidine, an alpha 2-adrenergic receptor agonist, this study examined the relationship between the noradrenergic system and the HPA axis in 10 patients with major depression (4 unipolar, 6 bipolar), 10 patients with panic disorder, and 10 normal controls. Baseline cortisol was significantly elevated in depressed as compared with panic patients, but not with controls. Depressed patients also tended to exhibit a greater absolute fall in plasma cortisol (5.2 +/- 4.0 micrograms/dl) compared with panic patients (1.7 +/- 2.4 micrograms/dl) (p less than 0.06, t-test). When expressed as a percentage of baseline, however, the cortisol response to clonidine did not differ significantly between diagnostic groups (p greater than 0.10). Basal levels of cortisol were highly correlated with the degree of decrease in cortisol induced by clonidine in the group of 30 subjects (r = -0.81, p less than 0.0001). These findings are discussed in the context of the utility of clonidine as a probe of the functional relatedness of the noradrenergic system and the HPA axis in these disorders.
去甲肾上腺素能功能调节异常已被认为是抑郁和惊恐焦虑症病理学的一部分。然而，下丘脑 - 垂体 - 肾上腺（HPA）轴功能异常主要局限于抑郁症患者。本研究使用皮质醇对α2 - 肾上腺素能受体激动剂可乐定的反应，检测了10例重度抑郁症患者（4例单相抑郁，6例双相抑郁）、10例惊恐障碍患者和10名正常对照者的去甲肾上腺素能系统与HPA轴之间的关系。与惊恐障碍患者相比，抑郁症患者的基线皮质醇水平显著升高，但与对照组相比无差异。与惊恐障碍患者（1.7±2.4微克/分升）相比，抑郁症患者血浆皮质醇的绝对下降幅度也更大（5.2±4.0微克/分升）（p＜0.06，t检验）。然而，以基线的百分比表示时，可乐定引起的皮质醇反应在各诊断组之间无显著差异（p＞0.10）。在30名受试者中，皮质醇的基础水平与可乐定诱导的皮质醇下降程度高度相关（r = -0.81，p＜0.0001）。本文结合可乐定作为这些疾病中去甲肾上腺素能系统与HPA轴功能相关性探针的实用性对这些发现进行了讨论。
