[Cortisol secretion in depressed patients. Review of the literature]

The authors present a critical overview of the multiple and contradictory studies of cortisol production in depressed patients. Some notions of physiology are first recalled. A main part of the review discusses the dexamethasone suppression test, but studies of the cortisol secretion profile and of other dynamic tests are also presented. One can describe in depressed people: cortisol overproduction, an impaired negative feedback mechanism, an adrenocortical hyperreactivity to ACTH and a phase advance in the circadian rhythm of cortisol secretion. These anomalies are more frequently encountered in patients exhibiting severe depressions of the endogenomorphic type. However, none of them can be considered as a biological marker of depression, nor as a marker for a particular type of depression. The relation between endocrine disturbances and the clinical parameters of depression is still controversial.