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Cortisol Production in Depressive Illness A Clinical and Biochemical Clarification

Edward J. Sachar, MD; Leon Hellman, MD; David K. Fukushima, PhD; T. F. Gallagher, PhD
Arch Gen Psychiatry. 1970;23(4):289-298. doi:10.1001/archpsyc.1970.01750040001001.
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THIS paper will attempt to clarify the relation of clinical features of depressive illness to the secretory activity of the adrenal cortex.

The discovery that psychological stress stimulates the anterior pituitary-adrenocortical system1 has led to considerable interest in studying the function of the adrenal cortex in patients with mental illnesses, including depressions. In a recent review paper,2 Sachar pointed out that the extensive literature describing levels of adrenocortical hormones in depressed patients was quite inconsistent, with many reports suggesting elevated corticosteroid levels and other reports suggesting normal corticosteroid levels, some suggesting good correlation of severity of illness with adrenocortical indices, and others reporting poor correlations. It appeared that neglect of several significant control issues had contributed to the apparent diversity in findings. These necessary controls include eliminating all drugs which may interfere with the release of adrenocorticotropic hormone (ACTH), giving the patient enough time to get over


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