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Dissociation Between Pituitary and Adrenal Suppression to Dexamethasone in Depression

Elizabeth A. Young, MD; Joan Kotun, MD; Roger F. Haskett, MD; Leon Grunhaus, MD; John F. Greden, MD; Stanley J. Watson, MD, PhD; Huda Akil, PhD
Arch Gen Psychiatry. 1993;50(5):395-403. doi:10.1001/archpsyc.1993.01820170073010.
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Objective:  To determine if corticotroph nonsuppression, as reflected by β-endorphin nonsuppression, occurs before cortisol nonsuppression (defined as a cortisol level of >140 nmol/L) when examining multiple time points in a day.

Setting:  The General Medical Clinical Research Center and Inpatient Depression Research Unit, Ann Arbor, Mich.

Design:  Multiple blood samples were obtained through an intravenous catheter around the time points of 8 AM, noon, and 4 PM and assayed for β-endorphin and cortisol.

Patients:  Patients meeting Research Diagnostic Criteria for the diagnosis of major depressive disorder, primary and simple. A total of 73 subjects, both inpatients and outpatients, were studied.

Intervention:  Samples were obtained both at baseline and 1 day after administration of 1 mg of dexamethasone at 11:30 PM.

Measurements and Results:  Overall 39 patients (53%) demonstrated β-endorphin nonsuppression after administration of dexamethasone at any of the three time points, while only eight patients (11%) demonstrated cortisol nonsuppression at any of these time points. Cortisol nonsuppression, but not β-endorphin nonsuppression, was associated with lower concentrations of dexamethasone in plasma. Baseline cortisol and menopausal status were significantly associated with β-endorphin nonsuppression in women.


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