Trestman R L, Coccaro E F, Mitropoulou V, Gabriel S M, Horvath T, Siever L J
Psychiatry Service, Bronx VA Medical Center, N.Y. 10468.
Biol Psychiatry. 1993 Sep 15;34(6):373-9. doi: 10.1016/0006-3223(93)90181-c.
To assess the relationship between the hypothalamo-pituitary-adrenal (HPA) axis and the noradrenergic system in patients with major depression, 26 normal controls, 32 acutely depressed patients, and 21 patients with remitted depression, all men, were administered intravenous clonidine (2 micrograms/kg) or placebo. Acute, but not remitted, depressed patients had a greater plasma cortisol baseline than did normal controls (t = 2.0, p < 0.03). Only acutely depressed patients had a greater decrease in plasma cortisol in response to clonidine than to placebo (t = 2.5, p < 0.02). Statistically controlling for both diurnal variation and baseline cortisol, acute, but not remitted, depressed patients had a greater decrease in plasma cortisol in response to clonidine than did the controls (analysis of covariance: F[1,35] = 4.26, p < 0.05). These results support a state-dependent noradrenergic-HPA axis regulatory disturbance in depressed patients, suggesting that clonidine inhibits the elevated plasma cortisol in acute depression but not the normal concentrations observed in remitted depression or healthy controls.
为评估重度抑郁症患者下丘脑 - 垂体 - 肾上腺（HPA）轴与去甲肾上腺素能系统之间的关系，对26名正常对照者、32名急性抑郁患者和21名缓解期抑郁患者（均为男性）静脉注射可乐定（2微克/千克）或安慰剂。急性抑郁患者（而非缓解期抑郁患者）的血浆皮质醇基线水平高于正常对照者（t = 2.0，p < 0.03）。仅急性抑郁患者对可乐定的血浆皮质醇降低幅度大于对安慰剂的降低幅度（t = 2.5，p < 0.02）。在对昼夜变化和皮质醇基线进行统计学控制后，急性抑郁患者（而非缓解期抑郁患者）对可乐定的血浆皮质醇降低幅度大于对照者（协方差分析：F[1,35] = 4.26，p < 0.05）。这些结果支持抑郁症患者存在状态依赖性去甲肾上腺素能 - HPA轴调节紊乱，提示可乐定可抑制急性抑郁症患者升高的血浆皮质醇，但对缓解期抑郁症患者或健康对照者的正常皮质醇浓度无抑制作用。
