Twenty-four-hour ACTH and cortisol pulsatility in depressed women

Increased plasma cortisol in patients with major depression is a well docum ented finding, although it is present in only 25-30% of subjects with major depression. However, ACTH and cortisol are secreted in a pulsatile manner, so it is unclear if increased ACTH secretion occurs in depression and if t here are changes in the pulsatile components of ACTH secretion. Ten-minute sampling for ACTH and cortisol was performed for 24 hr in 25 premenopausal depressed women, whose age and menstrual cycle day matched control women. A s a group, the depressed women demonstrated a trend to increase cortisol se cretion (p=0.089). There was no difference in mean cortisol between the pat ient group as a whole (8.36 +/-2.9 mug/dl) and those patients meeting crite ria for atypical depression (8.38 +/-1.9 mug/dl), but patients meeting crit eria for endogenous showed increased cortisol (12.17 +/-4 mug/dl) Mean ACTH was not significantly different between patients and controls. Pulse analy ses revealed similar number of secretory events and similar amplitudes for cortisol secretory bursts in patients and controls. The baseline component area under the curve of cortisol secretion was increased at a trend level ( p =.064) in depressed patients, and the baseline AUC for ACTH was significa ntly increased in depressed patients (p = .045). No differences were found in pulsatile components of ACTH secretion between patients and matched cont rols. Harmonic analyses indicated no significant differences between patien ts and controls on any detected rhythm for ACTH or cortisol. These data sug gest that the pulsatile and circadian components of the HPA axis are normal in premenopausal depressed women and that only 24% of depressed women demo nstrate hypercortisolemia. [Neuropsychopharmcology 25:267-276,2001] (C) 200 1 American College of Neuropsychopharmcology. Published by Elsevier Science Inc.