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Evidence for Abnormal Corticosteroid-Catecholamine Interactions in Major Depression

Owen M. Wolkowitz, MD; Allen R. Doran, MD; Allan Breier, MD; Alec Roy, MB; David C. Jimerson, MD; Mary E. Sutton; Robert N. Golden, MD; Steven M. Paul, MD; David Pickar, MD

Arch Gen Psychiatry. 1987;44(9):782-789.

Abstract
• We investigated the possible interactions between corticosteroids and catecholamines in depression by studying the effects of the synthetic glucocorticoid dexamethasone on plasma levels of homovanillic acid (HVA) and 3-methoxy-4--hydroxyphenylglycol (MHPG) in a group of depressed patients and normal controls. In comparison with metabolite levels on a control day, normal controls showed a significant dexamethasone-induced increase in the plasma HVA level and a trend toward a decrease in the plasma MHPG level at 4 PM following dexamethasone administration (1 mg orally at 11 PM). Conversely, depressed patients, particularly those with psychotic features, showed a significant dexamethasone-induced increase in the plasma MHPG level and a blunting of the plasma HVA response relative to the normal controls. Dexamethasoneinduced increases in the plasma MHPG level were directly correlated with the severity of depressive symptoms and with postdexamethasone cortisol levels in the depressed patients. These data suggest abnormal corticosteroid-catecholamine interactions in depression and, specifically, in depressed patients with psychotic features.

Author Affiliations
From the Sections on Clinical Studies, Clinical Neurosciences Branch (Drs Wolkowitz, Doran, Breier, Roy, Paul, and Pickar, and Ms Sutton), Biomedical Science, Laboratory of Clinical Science (Dr Jimerson), and Clinical Pharmacology, Laboratory of Clinical Science (Dr Golden), National Institute of Mental Health, Bethesda, Md. Dr Wolkowitz is now with the University of California, San Francisco; Dr Doran is with the University of California, Davis; Dr Roy is with the National Institute on Alcohol Abuse and Alcoholism, Bethesda, Md; and Dr Golden is with the University of North Carolina, Chapel Hill.

Footnotes
Accepted for publication March 4, 1987.

Reprint requests to Section on Clinical Studies, Clinical Neurosciences Branch, National Institute of Mental Health, Bldg 10, Room 4N212, Bethesda, MD 20892 (Dr Pickar).

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