L J Whalley

Glucocorticoid receptors and depression

The number of glucocorticoid receptor sites in lymphocytes was estimated and plasma cortisol concentrations measured in 17 depressed patients, 12 patients with chronic schizophrenia, and 31 healthy control subjects. The number of receptor sites was significantly lower in the depressed patients than in either the controls or the patients with chronic schizophrenia, but there were no differences between the groups in the dissociation constants of the glucocorticoid receptors or the plasma cortisol concentrations. When two control subjects were studied intensively over 28 hours a slight diurnal variation in the number of glucocorticoid receptors was detected. The lower numbers of glucocorticoid receptors in the lymphocytes of depressed patients may explain why such patients, who often have hypercortisolaemia, do not show the clinical features of excess production of cortisol.

IMMEDIATE INCREASES IN PLASMA PROLACTIN AND NEUROPHYSIN BUT NOT OTHER HORMONES AFTER ELECTROCONVULSIVE THERAPY

Plasma prolactin, growth hormone, cortisol, luteinising-hormone-releasing hormone (LHRH), thyrotropin-releasing hormone (TRH), and nicotine and oestrogen stimulated neurophysin (NSN and ESN) were measured before and for 6 min after electroconvulsive therapy (ECT) in eight women with severe electroconvulsive therapy (ECT) in eight women with severe depression. Plasma concentrations of NSN and ESN had increased significantly (as much as 10-fold for NSN) within 1 min of the seizure, and concentrations of prolactin had increased within 2-4 min after the seizure. Whereas plasma prolactin and ESN either continued to increase or remained raised throughout the 6 min after seizure, the concentrations of NSN fell to reach a value at 6 min that was approximately 50% of the maximum. There were no increases in any of the other hormones or peptides within the 6 min period under study. Thus ECT has selective effects on hormone release which cannot be attributed simply to a generalised release of pituitary or hypothalamic hormones in response to brain stimulation and/or stress.

OESTROGEN-STIMULATED NEUROPHYSIN AND OUTCOME AFTER ELECTROCONVULSIVE THERAPY

Plasma concentrations of oestrogen-stimulated neurophysin (ESN), prolactin, and growth hormone were measured before and after the first treatment in a course of electroconvulsive therapy (ECT) given to 25 psychiatric patients and during induction of anaesthesia in 9 women undergoing elective cholecystectomy. Prolactin levels rose and growth hormone levels fell during both cholecystectomy and ECT, but ESN levels rose only after ECT. The peak ESN response to ECT was significantly greater (p less than 0.005) in the 16 depressed patients who recovered than in the 9 who did not. All patients in whom plasma ESN concentration increased by more than 100% satisfactorily recovered from their depressive illness. If a 63% increase in ESN concentration is used to classify all subjects, 12% are misclassified by outcome at 2 months. The extent of the ESN response, but not the prolactin or growth hormone responses, correlated with improvement in symptoms measured by Hamilton Rating Scale for Depression and the Montgomery and Asberg Depression Rating Scale.

Elevated plasma luteinizing hormone concentrations, cryptorchidism and mania

A young man with acute mania and unilateral cryptorchidism had plasma luteinizing hormone (LH) concentrations that were much higher than the maximum LH concentrations we have found in normal subjects and patients with schizophrenia. Plasma concentrations of testosterone and sex hormone binding globulin were not abnormal, showing that the elevated plasma LH concentrations were probably due to increased secretion of LH-releasing hormone (LHRH). This case supports our previous results which suggest that an abnormally high secretion of LHRH, due presumably to an abnormality in central neurotransmission, may be a feature of acute mania in young men.