Cortisol activity and cognitive changes in psychotic major depression

Objective: The theory that psychotic major depression is a distinct syndrom e is supported by reports of statistically significant differences between psychotic and nonpsychotic major depression in presenting features, biologi cal measures, familial transmission, course and outcome, and response to tr eatment. This study examined differences in performance on a verbal memory test and in cortisol levels between patients with psychotic and nonpsychoti c major depression and healthy volunteers. Method. Ten patients with psychotic major depression, 17 patients with nonp sychotic major depression, and 10 healthy volunteers were administered the Wallach Memory Recognition Test and had blood drawn at half-hour intervals over the course of an afternoon to assay cortisol levels. Results: Subjects with psychotic major depression had a higher rate of erro rs of commission on the verbal memory test (incorrectly identified distract ers as targets) than did subjects with nonpsychotic major depression or hea lthy volunteers; errors of omission were similar among the three groups. Su bjects with psychotic major depression had higher cortisol levels throughou t the afternoon than subjects with nonpsychotic major depression or healthy volunteers. This effect became even more pronounced later in the afternoon . Conclusions: Psychotic major depression is endocrinologically different fro m nonpsychotic major depression and produces cognitive changes distinct fro m those seen in nonpsychotic major depression.