CORTICOTROPIN-RELEASING HORMONE CHALLENGE IN PREPUBERTAL MAJOR DEPRESSION

This study investigates cortisol and ACTH (corticotropin) responses to an infusion of human CRH (corticotropin-releasing hormone) in prepube rtal children with major depressive disorder (MDD). Following a period of 24 hours of adaptation to the laboratory environment with an intra venous catheter in place, 34 children with MDD and 22 healthy controls received 1 mu g/kg of human CRH at 5:00 PM. Blood samples for cortiso l and ACTH were measured at baseline and post-CRH. Overall, there were no significant differences between the MDD and the normal controls in baseline or post CRH stimulation values of either cortisol or ACTH. M elancholic (n = 4) patients had significantly higher baseline cortisol levels than nonmelancholic (n = 24) patients. Compared with the outpa tients and the nonmelancholics, the inpatients (n = 10) and the melanc holics showed significantly lower total ACTH secretion (effect size: 0 .9 and 1.4, respectively) after CRH infusion. These results are consis tent with a broad literature suggesting that the HPA axis abnormalitie s occur less frequently in early-onset depression than reported in adu lt studies. The pattern of results in the subgroups of inpatients and in melancholic children, however, raise questions about possible conti nuities with adult studies.