EFFECTS OF ANTIDEPRESSANT TREATMENT ON CORTICOTROPIN-INDUCED CORTISOLRESPONSES IN PATIENTS WITH MELANCHOLIC DEPRESSION

To date, there appears to be no consensus of opinion as to whether the adrenal glands are hyperresponsive during depression and, if so, whet her this a state-dependent phenomenon. We aimed to determine the effec ts of antidepressant treatment on ACTH-induced cortisol responses in p atients with melancholic depression. Seven female patients with DSM-II I-R major depressive disorder, non-psychotic, melancholic subtype, wer e evaluated using the following rating scales: the Hamilton Depression Rating Scale, the Montgomery-Asberg Depression Rating Scale and the N ewcastle Endogenicity Scare. All subjects were then given an intraveno us bolus dose (250 mu g) of tetracosactrin, a potent stimulus of adren ocortical hormone secretion. Plasma levels of cortisol were measured a t times 0, +30, +60, +90, +120 and +180 min. Patients were then random ised to receive either 50 mg of sertraline or 20 mg of paroxetine (bot h of which are selective serotonin re-uptake inhibitors) and were re-t ested while medication-free. Treatment resulted in a significant decre ase in delta (the difference between the baseline values and the maxim um increase post-ACTH administration) cortisol values of 1633.3 +/- 37 8.5 nmol/l vs. 595.1 +/- 207.7 nmol/l. Successful pharmacological trea tment of major depressive disorder appears to be associated with a red uction in ACTH-induced cortisol release in drug-free patients. (C) 199 7 Elsevier Science Ireland Ltd.