Hypothalamic-pituitary-adrenal axis early-feedback responses are preservedin melancholic depression: A study of sertraline treatment

Major depression with melancholia is associated with hypercortisolaemia. Lo ss of the early-phase of negative feedback - acute suppression of ACTH in r esponse to rising cortisol levels - is the subject of conflicting reports i n patients with major depression. Using a within-subjects design, six patie nts with DSM-IIIR melancholic depression received a 60 min infusion of hydr ocortisone at 0900 with measurement of ACTH and cortisol before and after 4 weeks of antidepressant treatment. Ail patients responded clinically. ACTH responses (early feedback) did not differ between test conditions. Baselin e cortisol fell significantly following treatment response. This provides f urther evidence for the preservation of the acute phase of negative feedbac k, even in the presence of hypercortisolism. Copyright (C) 2000 John Wiley & Sons, Ltd.