Urinary free cortisol in psychotic depression

Major depression with psychotic features may be associated with higher cortisol secretion and a greater probability of dexamethasone nonsuppression of serum cortisol than is found in major depression without psychotic features. In this study, urinary free cortisol (UFC), a sensitive parameter of 24-hr cortisol production, was examined both before and after dexamethasone administration in 32 patients with major depression, 18 with psychotic features (MDPF), and 14 without psychotic features (MDD). A significantly larger number of MDPF patients had UFC excretion greater than 90 micrograms/24 hr before dexamethasone administration and greater than 20 micrograms/24 hr after dexamethasone administration. Although some clinical variables other than psychotic features differed between the two groups, these could not account for the UFC differences. However, the older patients (greater than 55 years) in the MDPF group accounted for the high UFC excretion, suggesting an interaction between age and diagnosis.