Stressors, central monoamine balance, and overactivation of the hypothalamic-pituitary-adrenal axis in depression

Abstract

Most clinical studies on the dexamethasone suppression test (DST) in depression have considered its rôle as a marker for melancholic episodes. In this study on 107 acutely ill patients with RDC major depressive disorders (60% suffered from DSM-III melancholia) an attempt is made to estimate the relative importance of external stressors precipitating the depression and one CSF measure of central serotonin-dopamine balance (a transformed ratio of HVAISHIAA) in eliciting dexamethasone non-suppression. The monoamine balance measure was highly significantly and negatively related to non-suppression, equally much in melancholia and in non-melancholia. Subjective and objective stressors, however, contributed to non-suppression only in the melancholic subgroup. Non-suppression in non-melancholia was unrelated to stress. Stressors were found to a similar extent in the two subgroups. These results suggest (i) a particular hypercortisolemic vulnerability to stressors in melancholia and (ii) the state of cerebral serotonin-dopamine balance as an important regulatory mechanism in the control of plasma cortisol.

Key Words:

• Cortisol
• Depression
• Dexamethasone suppression test
• Dopamine
• Melancholia
• SADS
• Serotonin
• Stress