Cortisol hypersecretion in unipolar major depression with melancholic and psychotic features: Dopaminergic, noradrenergic and thyroid correlates

Evidence supports that hyperactivity of the hypothalamic–pituitary–adrenal axis has a pivotal role in the psychobiology of severe depression. The present study aimed at assessing hypothalamic–pituitary dopaminergic, noradrenergic, and thyroid activity in unipolar depressed patients with melancholic and psychotic features and with concommitant hypercortisolemia. Hormonal responses to dexamethasone, apomorphine (a dopamine receptor agonist), clonidine (an alpha 2–adrenoreceptor agonist) and 0800 and 2300 h protirelin (TRH) were measured in 18 drug–free inpatients with a DSM–IV diagnosis of severe major depressive disorder with melancholic and psychotic features showing cortisol nonsuppression following dexamethasone and 23 matched hospitalized healthy controls. Compared with controls, patients showed (1) lower adrenocorticotropin and cortisol response to apomorphine ( p