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Its Relationship to Classification

Michael A. Schlesser, MD; George Winokur, MD; Barry M. Sherman, MD

Arch Gen Psychiatry. 1980;37(7):737-743.

Abstract
• Serum cortisol response to the 1-mg overnight dexamethasone suppression test was studied in 221 depressed patients and 109 nondepressed psychiatric controls. Nonsuppression distinguished patients with primary unipolar depression (65/ 146) from patients with secondary unipolar depression (0/42) and nondepressed controls (0/109). Furthermore, nonsuppression distinguished the three familial subtypes of primary unipolar depressive illness: familial pure depressive disease (FPDD; 38/50 patients), sporadic depressive disease (SDD; 24/55 patients), and depression spectrum disease (3/41 patients). Moderate elevations in baseline serum cortisol levels were found in FPDD, SDD, and bipolar depression. Medication did not affect the results. The data suggest that the depressive syndrome is composed of separate illnesses, each of which has a distinctive pattern of hypothalamic-pituitary-adrenal axis activity during the depressed state as well as a specific clinical and familial psychiatric history.

Author Affiliations
From the Departments of Psychiatry (Drs Schlesser and Winokur) and Internal Medicine (Dr Sherman), University of Iowa College of Medicine, Iowa City, Iowa.

Footnotes
Accepted for publication Feb 22, 1980.

Reprint requests to Department of Psychiatry, University of Iowa College of Medicine, 500 Newton Rd, Iowa City, IA 52242 (Dr Winokur).

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