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Hormonal Responses to Fenfluramine in Depressive Subtypes

Published online by Cambridge University Press:  02 January 2018

Philip Mitchell*
Affiliation:
School of Psychiatry, University of New South Wales, Sydney
George Smythe
Affiliation:
C. E. Heath Neuroscience Laboratory, Garvan Institute of Medical Research, Sydney, and University of New South Wales
Gordon Parker
Affiliation:
School of Psychiatry, University of New South Wales
Kay Wilhelm
Affiliation:
Division of Psychiatry, Prince Henry Hospital, and University of New South Wales
Ian Hickie
Affiliation:
Division of Psychiatry, Prince Henry Hospital, and University of New South Wales
Henry Brodaty
Affiliation:
Division of Psychiatry, Prince Henry Hospital, and School of Psychiatry, University of New South Wales
Philip Boyce
Affiliation:
School of Psychiatry, University of New South Wales
*
Mood Disorders Unit, Prince Henry Hospital, Little Bay, NSW, 2036 Australia

Abstract

In order to study putative differences in central neurotransmitter function in depressive subtypes, serum Cortisol and prolactin responses to the putative serotonin agonist fenfluramine were examined in 30 subjects with major depression. Patients with endogenous depression (melancholia) as defined by each of ICD–9, DSM–III, RDC and Newcastle scale demonstrated a reduced prolactin response to 60 mg oral fenfluramine when compared with non-endogenous subjects. This was independent of either prolactin or Cortisol baseline levels, and indicates that there are differences in brain neurotransmitter function in the endogenous and non-endogenous subtypes of depression. Basal prolactin levels were reduced in bipolar compared with unipolar subjects, and delusional compared with non-delusional patients, although there were no differences in the prolactin responses to fenfluramine between these subgroups. Basal Cortisol levels and Cortisol response to fenfluramine did not distinguish between any of the subtypes.

Type
Papers
Copyright
Copyright © Royal College of Psychiatrists, 1990 

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References

American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM–III). Washington, DC: APA.Google Scholar
Anderson, I. M., Crook, W. S., Garside, S. E., et al (1989) Effect of moderate weight loss on prolactin secretion in normal female volunteers. Psychiatry Research, 29, 161167.Google Scholar
Andreasen, N. C. (1982) Concepts, diagnosis and classification. In Handbook of Affective Disorders (ed. E. S. Paykel), pp. 2444. Edinburgh: Churchill Livingstone.Google Scholar
Barbieri, C., Bigatti, G., Rauhe, W. G., et al (1984) Serotonergic regulation of Cortisol secretion in dogs. Endocrinology, 115, 748751.Google Scholar
Baumgartner, A., Graef, K-J. & Kuerten, I. (1988) Prolactin in patients with major depressive disorders and in healthy subjects: 1. Cross-sectional study of basal and post-TRH and post-dexamethasone prolactin levels. Biological Psychiatry, 24, 249267.Google Scholar
Brodaty, H., Boyce, P., Wilhelm, K., et al (1987) The establishment of a mood disorders unit. Australian and New Zealand Journal of Psychiatry, 21, 375382.Google Scholar
Carney, M. W. P., Roth, M. & Garside, R. F. (1965) The diagnosis of depressive symptoms and the prediction of ECT response. British Journal of Psychiatry, 111, 639645.CrossRefGoogle Scholar
Carroll, B. J. (1989) Diagnostic validity of laboratory studies: rules of the game. In The Validity of Psychiatric Diagnosis (eds L. Robins & J. E. Barrett). New York: Raven Press.Google Scholar
Carroll, B. J., Feinberg, M., Greden, J. F., et al (1980) Diagnosis of endogenous depression: comparison of clinical research and neuroendocrine criteria. Journal of Affective Disorders, 2, 177194.Google Scholar
Carroll, B. J., Feinberg, M., Greden, J. F., et al (1981) A specific laboratory test for the diagnosis of melancholia. Standardization, validation and clinical utility. Archives of General Psychiatry, 38, 1522.Google Scholar
Checkley, S. A. (1979) Corticosteroid and growth hormone responses to methylamphetamine in depressive illness. Psychological Medicine, 9, 107115.Google Scholar
Checkley, S. A. (1980) Neuroendocrine tests for monoamine function in man: a review of basic theory and its application to the study of depressive illness. Psychological Medicine, 10, 3553.Google Scholar
Checkley, S. A., Glass, I. B., Thompson, C., et al (1984) The GH response to clonidine in endogenous as compared with reactive depression. Psychological Medicine, 14, 773777.Google Scholar
Coccaro, E. F., Siever, L. J., Klar, H. M., et al (1989) Serotonergic studies in patients with affective and personality disorders: correlations with suicidal and impulsive aggressive behaviour. Archives of General Psychiatry, 46, 587599.Google Scholar
Cowen, P. J. & Charig, E. M. (1987) Neuroendrocrine responses to intravenous tryptophan in major depression. Archives of General Psychiatry, 44, 958966.Google Scholar
Davidson, J., Turnbull, C., Strickland, R., et al (1984) Comparative diagnostic criteria for melancholia and endogenous depression. Archives of General Psychiatry, 41, 506511.Google Scholar
Dolan, R. H. & Calloway, S. P. (1986) The human growth hormone response to clonidine: relationship to clinical and neuroendocrine profile in depression. American Journal of Psychiatry, 143, 772774.Google Scholar
Farmer, A. & McGuffin, P. (1989) The classification of the depressions: contemporary confusion revisited. British Journal of Psychiatry, 155, 437443.Google Scholar
Foulds, G. A. (1973) The relationship between the depressive illnesses. British Journal of Psychiatry, 123, 531533.CrossRefGoogle ScholarPubMed
Gillespie, R. D. (1929) The clinical differentiation of types of depression. Guy's Hospital Reports, 79, 306344.Google Scholar
Hamilton, M. (1967) Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology, 6, 278296.Google Scholar
Heninger, G. R., Charney, D. S. & Sternberg, D. E. (1984) Serotonergic function in depression: prolactin response to intravenous tryptophan in depressed patients and healthy subjects. Archives of General Psychiatry, 41, 398402.Google Scholar
Horton, R. W., Katona, C. L. E., Theodorou, A. E., et al (1986) Platelet radioligand binding and neuroendocrine challenge tests in depression. In Antidepressants and Receptor Function, Ciba Foundation Symposium, No. 123, pp. 84105. Chichester: Wiley.Google Scholar
Hsiao, J. K., Bartko, J. J. & Potter, W. Z. (1989) Diagnosing diagnoses: receiver operating characteristic methods and psychiatry. Archives of General Psychiatry, 46, 664667.Google Scholar
Jackson, R. V., Grice, J. E. & Jackson, A. J. (1988) Inhibition of serotonin-induced ACTH release in man by clonidine. Clinical and Experimental Pharmacology and Physiology, 15, 293298.Google Scholar
Joyce, P. R., Sellman, J. D., Donald, R. A., et al (1988) The unipolar-bipolar depressive dichotomy and the relationship between afternoon prolactin and Cortisol levels. Journal of Affective Disorders, 14, 189193.Google Scholar
Joyce, P. R. & Paykel, E. S. (1989) Predictors of drug response in depression. Archives of General Psychiatry, 46, 8999.Google Scholar
Lewis, D. A. & Sherman, B. M. (1984) Serotonergic stimulation of adrenocorticotropin secretion in man. Journal of Clinical Endocrinology and Metabolism, 58, 458462.Google Scholar
Lopez-Ibor, J. J., Saiz-Ruiz, J. & Iglesias, L. M. (1988) The fenfluramine challenge test in the affective spectrum: a possible marker of endogeneity and severity. Pharmacopsychiatry, 21, 914.Google Scholar
Lopez-Ibor, J. J., Saiz-Ruiz, J. & Iglesias, L. M. (1989) Neuroendocrine challenges in the diagnosis of depressive disorders. British Journal of Psychiatry, 154 (suppl. 4), 7376.Google Scholar
Lykouras, E., Markianos, M., Milliaras, D., et al (1988) Neurochemical variables in delusional depression. American Journal of Psychiatry, 145, 214217.Google Scholar
Madansky, A. (1988) Prescriptions for Working Statisticians. New York: Springer-Verlag.Google Scholar
Maes, M., De Ruyter, M., Claes, R., et al (1987) The Cortisol responses to 5-hydroxytryptophan, orally, in depressive inpatients. Journal of Affective Disorders, 13, 2330.CrossRefGoogle ScholarPubMed
Matussek, N., Ackenheil, M., Hippius, H., et al (1980) Effect of clonidine on growth hormone release in psychiatric patients and controls. Psychiatry Research, 2, 2536.Google Scholar
Meltzer, H. Y., Umberkoman-Wiita, B., Robertson, A., et al (1984) Effect of 5-hydroxytryptophan on serum Cortisol levels in major affective disorders: 1. Enhanced response in depression and mania. Archives of General Psychiatry, 41, 366374.Google Scholar
Mendlewicz, J., Van Cauter, E., Linkowski, , et al (1980) The 24–hour profile of prolactin in depression. Life Sciences, 27, 20152024.Google Scholar
Mitchell, P. & Smythe, G. (1990) Hormonal responses to fenfluramine in depressed and control subjects. Journal of Affective Disorders, 19, 4356.Google Scholar
Nutt, D. J. & Cowen, P. J. (1987) Diazepam alters brain 5-HT function in man: implications for the acute and chronic effects of benzodiazepines. Psychological Medicine, 17, 601607.Google Scholar
Quattrone, A., Tedeschi, G., Aguglia, U., et al (1983) Prolactin secretion in man: a useful tool to evaluate the activity of drugs on central 5-hydroxytryptaminergic neurones. Studies with fenfluramine. British Journal of Clinical Pharmacology, 16, 471475.Google Scholar
Roy, A., Pickar, D., Linnoila, M., et al (1985) Plasma norepinephrine level in affective disorders. Archives of General Psychiatry, 42, 11811185.CrossRefGoogle ScholarPubMed
Roy, A., Pickar, D., Douillet, P., et al (1986) Urinary monoamines and monoamine metabolites in subtypes of unipolar depressive disorder and normal controls. Psychological Medicine, 16, 541546.Google Scholar
Shapira, B., Reiss, A., Kaiser, N., et al (1989) Effect of imipramine treatment on the prolactin response to fenfluramine and placebo challenge in depressed patients. Journal of Affective Disorders, 16, 14.Google Scholar
Siever, L. J., Murphy, D. L., Slater, S., et al (1984) Plasma prolactin changes following fenfluramine in depressed patients compared to controls: an evaluation of central serotonergic responsivity in depression. Life Sciences, 34, 10291039.Google Scholar
Smythe, G. A., Bradshaw, J. E., Cai, W. Y., et al (1982) Hypothalamic serotonergic stimulation of thyrotropin secretion and related brain-hormone and drug interactions in the rat. Endocrinology, 111, 11811191.Google Scholar
Spitzer, R. L., Endicott, J. & Robins, E. (1978) Research diagnostic criteria: rationale and reliability. Archives of General Psychiatry, 35, 773782.Google Scholar
Storlien, L. H. & Smythe, G. A. (1990) D-fenfluramine effects on hypothalamic monoamine activities and their hormonal correlates. Life Sciences (in press).Google Scholar
Van de Kar, L. D., Urban, J. H., Richardson, K. D., et al (1985) Pharmacological studies on the serotonergic and non-serotonin-mediated stimulation of prolactin and corticosterone secretion by fenfluramine. Neuroendocrinology, 41, 283288.Google Scholar
Van Praag, H. M., Korf, J. & Puite, J. (1970) 5-hydroxyindo-leacetic acid levels in the cerebrospinal fluid of depressive patients treated with probenecid. Nature, 225, 12591260.Google Scholar
Van Praag, H. M., Lemus, C. & Kahn, R. (1987) Hormonal probes of central serotonergic activity: do they really exist? Biological Psychiatry, 22, 8698.Google Scholar
Weizman, A., Mark, M., Gil-Ad, I., et al (1988) Plasma Cortisol, prolactin, growth hormone and immunoreactive B-endorphin response to fenfluramine challenge in depressed patients. Clinical Neuropharmacology, 11, 250256.Google Scholar
Willoughby, J., Menadue, M. & Jervois, P. (1982) Function of serotonin in physiological secretion of growth hormone and prolactin and p-clorophenylalanine. Brain Research, 249, 291299.CrossRefGoogle Scholar
World Health Organization (1978) Mental Disorders: Glossary and Guide to their Classification in Accordance with the Ninth Revision of the International Classification of Disease (ICD–9). Geneva: WHO.Google Scholar
Zung, W. W. K. (1965) A self-rated depression scale. Archives of General Psychiatry, 12, 6370.CrossRefGoogle Scholar
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