Editorial: Endocrinology and psychiatry

Adrenal steroids and the physiopathology of a subset of depressive disorders

Patients suffering from Cushing's disorders (syndrome and disease) are significantly affected by psychological disturbances that overlap with depressive disorders. In turn, a subset of patients with affective disorders present with hypercortisolemia, and non-suppression in the Dexamethasone Suppression Test (DST). We have shown that long-term potentiation (LTP), a putative memory mechanism, is significantly affected by steroids when tested on the hippocampus, a crucial structure for memory processes. We propose that an imbalance of adrenal steroids and their metabolites, interacting at the level of the hippocampus, play a fundamental role in the psychophysiopathology of Cushing's and depressive disorders. By biasing memory mechanisms, the imbalance of these hormones sets both distorted mood, and hence memory contents, and distorted cognition based on recollection and present experiences.

Urinary free cortisol excretion in depression

Urinary free cortisol (UFC) excretion was determined in 60 depressed inpatients and in 35 psychiatric inpatients with other disorders. The depressed patients had high daily UFC values, while the other patients excreted normal amounts. Over 40% of the depressed patients had UFC excretions in the range seen in Cushing's disease, while only 6% of the other patients excreted such high amounts of cortisol. Age and sex differences did not account for the results. Among the depressed patients those with depressive neuroses excreted less than unipolar or bipolar depressives. Following treatment, more normal UFC excretion was found in depressed patients. The estimation of UFC and its clinical utility are discussed in detail. UFC determination is a simple and informative indicator of adrenal cortical activation and its application to psychoendocrine studies is recommended.