ANGER ATTACKS IN UNIPOLAR DEPRESSION .2. NEUROENDOCRINE CORRELATES AND CHANGES FOLLOWING FLUOXETINE TREATMENT

Objective: Neuroendocrine derangements have been reported in both depr ession and aggressive behavior. The purpose of this study was to evalu ate whether the subset of depressed patients with anger attacks have a distinctive neuroendocrine abnormality. Method: The thyrotropin-relea sing hormone (TRH) test was administered to 25 patients with major dep ression, 12 of whom reported having anger attacks, at the Depression R esearch Program of the Clinical Psychopharmacology Unit at the Massach usetts General Hospital. Twenty-two subjects underwent the TRH test ag ain after 8 weeks of treatment with fluoxetine, a relatively selective serotonin uptake inhibitor. Results: The depressed patients with ange r attacks bad a blunted prolactin response to TRH stimulation compared to the depressed patients without anger attacks. Treatment with fluox etine was followed by an overall increase in the prolactin response to TRH among the depressed patients with anger attacks. The prolactin re sponse to TRH also tended to predict the degree of response to treatme nt. Conclusions: These results suggest that the subset of depressed pa tients with anger attacks may have a greater central serotonergic dysr egulation than depressed patients without such attacks.