Salivary cortisol levels and their correlation with plasma ACTH levels in depressed patients before and after the DST

Article Abstract:

Adrenocorticotropic hormone (ACTH) is a hormone secreted by the pituitary gland which stimulates the adrenal cortex to secrete cortisol. Cortisol, in turn, regulates aspects of metabolism, modulates stress and anxiety and facilitates learning and memory. The hypothalamic-pituitary-adrenal (HPA) axis is a complicated, integrated biochemical network which releases hormones that also cause the adrenal cortex to secrete cortisol. Many studies have indicated abnormal activity of the HPA axis in depressive illness. Blood levels of cortisol are often used in psychiatry to evaluate this endocrine-hormonal disturbance. One technique to study HPA activity involves the dexamethasone suppression test (DST), which determines the ability of the drug dexamethasone to suppress the HPA axis for 24 hours. An inability to suppress the HPA axis has been associated with hypertension and depression. To study the utility of measuring cortisol levels in the saliva (rather than the blood) of depressed patients undergoing the DST, and to evaluate any relationship between salivary cortisol level and levels of plasma ACTH, 20 outpatients (15 women and 5 men) aged 20 to 65 years were studied. Eleven patients were diagnosed with major endogenous depression (caused by internal, presumably biochemical imbalances). The others were diagnosed with a depressed mood disorder (dysthymia) of a nonendogenous nature. A comparison group consisted of 12 healthy volunteers. Pre- and post-DST salivary cortisol levels were assessed for all subjects. Patients with major depression demonstrated significantly higher cortisol salivary levels pre-DST than the comparison and dysthymic groups. A significant relationship was found between plasma ACTH and pre-DST salivary cortisol levels in the dysthymic and comparison groups, but not in the group with major depression. Findings suggest that measures of salivary cortisol may be able to substitute for blood cortisol measures when using the DST. The lack of a relationship between ACTH and cortisol levels in major depression indicates an abnormality in the regulation of cortisol secretion. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Hydrocortisone, Hypothalamic-pituitary-adrenal axis, Dexamethasone, ACTH, Corticotropin, Pituitary hormone releasing factors, Pituitary hormone releasing hormones

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Depressive symptoms following stroke

Article Abstract:

To evaluate interactions between brain lesion location, depression, and eating or sleep disturbances, 52 men who had suffered a stroke were studied. The men were primarily Caucasian, with an average age of around 66 years. All were right-handed, and had lesions involving only one side of the brain. The average amount of time between the stroke and participation in the study was 16 months. The men were given a battery of mood and depression inventories, and tests to assess functional and speech impairment as well as eating and sleep disturbances. Lesion location was assessed by computerized tomography. No significant relationships were found between depressed mood and amount of functional impairment, or between eating disturbance and lesion location. However, several significant interactions involving lesion site, mood and sleep disturbances were found. Among the patients with right ventral or left dorsal lesions, those with nonfrontal damage were more depressed than those with frontal damage. Right dorsal frontal lesions resulted in more sleep disturbances than right nonfrontal dorsal damage. Patients with lesions in the left parietal or occipital areas were more depressed and had more sleep disturbance than patients with damage in the superior frontal lobe. Patients with left inferior frontal lobe lesions demonstrated more depression and sleep disturbance than those with temporal lobe damage. Right superior frontal lobe damage led to more depression and sleep disorders than damage to the right occipital or parietal lobes. Findings suggest that mood and sleep disorder may be part of a post-stroke clinical syndrome related to the emotional and cognitive processes associated with specific lesion sites. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cerebral circulation, Stroke (Disease), Stroke

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