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Episode and Recovery

Joaquim Puig-Antich, MD; Ronald Dahl, MD; Neal Ryan, MD; Hana Novacenko, MS; Deborah Goetz; Raymond Goetz, PhD; Janet Twomey; Timothy Klepper

Arch Gen Psychiatry. 1989;46(9):801-809.

Abstract
• Plasma cortisol concentrations were measured every 20 minutes for 24 hours in a group of 45 rigorously assessed, drugfree, prepubertal children who met the unmodified Research Diagnostic Criteria for major depressive disorder (MDD), 20 children with nonaffective psychiatric disorders, and eight normal controls. All children were studied in a low-stress environment. There were no significant differences in plasma cortisol concentration among the three groups as measured by 24-hour mean, peak, nocturnal rise, or nadir values. Division of the MDD group into subgroups based on endogenicity, psychotic symptoms, and suicidality also failed to reveal significant differences for cortisol secretion. Hypersecretion of cortisol (defined as 2 SDs above the grand mean) was identified in only four children with depressive illness and one normal control. Following clinical recovery, 24 depressed children were restudied in a drug-free state and compared with themselves during the episode of illness and with both groups of controls. No significant differences in plasma cortisol concentrations were found. All four depressed hypersecretors were restudied after clinical recovery, and one showed persistence of hypersecretion. These results suggest that abnormalities of cortisol secretion occur infrequently in prepubertal children with major depression when they are studied in a nonstressful environment.

Author Affiliations
From the Department of Child Psychiatry, New York State Psychiatric Institute, and the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York (Drs Puig-Antich, Ryan, and Goetz and Mss Novacenko and Goetz); and the Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh (Dr Dahl, Ms Twomey, and Mr Klepper). Drs Puig-Antich and Ryan are now with the Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh.

Footnotes
Accepted for publication Nov 10, 1988.

Reprints not available.

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