Neuroendocrine measures in psychiatric patients: course and outcome with ECT

Measures of neuroendocrine function--plasma cortisol and its response to dexamethasone, and plasma thyroid-stimulating hormone (TSH) and its response to thyrotropin-releasing hormone (TRH)--were employed in 50 hospitalized male veteran psychiatric patients with diagnoses of unipolar or bipolar melancholia, secondary depression, or schizophrenia. Of 20 cases of unipolar melancholia, 17 (85%) exhibited hypercortisolism; 14 (70%) failed to suppress plasma cortisol after dexamethasone; and 4 (31%) of 13 tested had an abnormal TSH response to intravenous TRH. Two patients with secondary depression also exhibited hypercortisolism; no other patients evinced abnormal neuroendocrine test results. These measures were repeated in 14 unipolar depressed patients after a course of electroconvulsive therapy (ECT). Improvement in psychopathology was directly related to normalization of measures of hypothalamic-pituitary-adrenal (HPA) function. The TSH response to TRH was not systematically altered. After a followup period of 1 to 9 months, there was a good correlation between the measures of HPA function and the clinical outcome. These findings encourage further study of HPA function measures as outcome criteria for depressed patients receiving ECT.