Heuser I J, Schweiger U, Gotthardt U, Schmider J, Lammers C H, Dettling M, Yassouridis A, Holsboer F
Max Planck Institute of Psychiatry, Munich, Germany.
Am J Psychiatry. 1996 Jan;153(1):93-9. doi: 10.1176/ajp.153.1.93.
This study was done to compare the effects of 6-week treatment with amitriptyline on hypothalamic-pituitary-adrenocortical (HPA) regulation in elderly depressed patients and age-matched comparison subjects.
A combined dexamethasone-suppression/CRH-stimulation (dexamethasone/CRH) test was administered before initiation of amitriptyline treatment and at the end of weeks 1, 3, and 6 of treatment. Thirty-nine depressed inpatients, mean age = 69 years, completed the study. Fourteen normal volunteers, mean age = 67 years, served as comparison subjects.
In relation to the comparison subjects, the depressed patients had a profoundly abnormal HPA response, in particular an exaggerated cortisol release in the dexamethasone/CRH test. This abnormality began to disappear after 1 week of treatment with amitriptyline. In contrast, amitriptyline did not affect neuroendocrine regulation in the comparison subjects at any time during the test period.
The data suggest that amitriptyline affects HPA regulation in hypercortisolemic depression only, and they raise the possibility that normalization of its feedback control is related to the antidepressive effect of amitriptyline.
本研究旨在比较阿米替林6周治疗对老年抑郁症患者和年龄匹配的对照受试者下丘脑 - 垂体 - 肾上腺皮质（HPA）轴调节的影响。
在开始阿米替林治疗前以及治疗第1、3和6周末进行联合地塞米松抑制/促肾上腺皮质激素释放激素刺激（地塞米松/促肾上腺皮质激素释放激素）试验。39名平均年龄为69岁的抑郁症住院患者完成了该研究。14名平均年龄为67岁的正常志愿者作为对照受试者。
与对照受试者相比，抑郁症患者的HPA反应严重异常，特别是在地塞米松/促肾上腺皮质激素释放激素试验中皮质醇释放过度。用阿米替林治疗1周后，这种异常开始消失。相比之下，在试验期间的任何时候，阿米替林均未影响对照受试者的神经内分泌调节。
数据表明，阿米替林仅影响高皮质醇血症性抑郁症中的HPA调节，并增加了其反馈控制正常化与阿米替林抗抑郁作用相关的可能性。
