Pituitary-adrenal function in adolescent psychiatric patients: impact of depressive symptoms

Background: The aim of this study was to determine whether depressive sympt oms affect pituitary-adrenal function in adolescents, as they do in adults. Methods: Salivary cortisol was measured before and after physical exercise in 23 hospitalized adolescent psychiatric patients and 13 age- and sex-mat ched healthy controls in a placebo-controlled design. In patients, cortisol profiles were assessed from 08:00 to 20:00 h before and after administrati on of low doses of dexamethasone or the natural steroid hydrocortisone. Pat ients were classified according to DSM III-R criteria and assigned to eithe r a depressed group (n = 10) or a non-depressed group (n = 13). Subjective depressive symptoms were rated with the 90-item symptom checklist. Results: Physical exercise increased cortisol output significantly in all subjects, but there were no differences between groups. in patients, no differences in basal cortisol levels were found between the depressed and non-depressed groups. Dexamethasone, but not hydrocortisone, was able to suppress cortis ol levels in both groups. Differences between groups were only found in tot al cortisol output over the 3 days when data were analyzed according to the patients 'subjective' feelings of depression, with the highest cortisol le vels in the 'subjectively more depressed' patients. Conclusions: The result s obtained only partially support the hypothesis that depressive symptoms i n adolescent psychiatric patients determine pituitary-adrenal (mal)function , and appear to depend on the strategy used. (C) 2000 Elsevier Science B.V. All rights reserved.