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Organization of the stress system and its dysregulation in melancholic and atypical depression: high vs low CRH/NE states.
Mol Psychiatry. 2002; 7(3):254-75.MP

Abstract

Stress precipitates depression and alters its natural history. Major depression and the stress response share similar phenomena, mediators and circuitries. Thus, many of the features of major depression potentially reflect dysregulations of the stress response. The stress response itself consists of alterations in levels of anxiety, a loss of cognitive and affective flexibility, activation of the hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system, and inhibition of vegetative processes that are likely to impede survival during a life-threatening situation (eg sleep, sexual activity, and endocrine programs for growth and reproduction). Because depression is a heterogeneous illness, we studied two diagnostic subtypes, melancholic and atypical depression. In melancholia, the stress response seems hyperactive, and patients are anxious, dread the future, lose responsiveness to the environment, have insomnia, lose their appetite, and a diurnal variation with depression at its worst in the morning. They also have an activated CRH system and may have diminished activities of the growth hormone and reproductive axes. Patients with atypical depression present with a syndrome that seems the antithesis of melancholia. They are lethargic, fatigued, hyperphagic, hypersomnic, reactive to the environment, and show diurnal variation of depression that is at its best in the morning. In contrast to melancholia, we have advanced several lines of evidence of a down-regulated hypothalamic-pituitary adrenal axis and CRH deficiency in atypical depression, and our data show us that these are of central origin. Given the diversity of effects exerted by CRH and cortisol, the differences in melancholic and atypical depression suggest that studies of depression should examine each subtype separately. In the present paper, we shall first review the mediators and circuitries of the stress system to lay the groundwork for placing in context physiologic and structural alterations in depression that may occur as part of stress system dysfunction.

Authors+Show Affiliations

Clinical Neuroendocrinology Branch, Intramural Research Program, NIMH/NIH, NIH Clinical Center, Room 2D-46-1284, Bethesda, MD 20892-1284, USA. philgold@codon.nih.govNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.
Review

Language

eng

PubMed ID

11920153

Citation

Gold, P W., and G P. Chrousos. "Organization of the Stress System and Its Dysregulation in Melancholic and Atypical Depression: High Vs Low CRH/NE States." Molecular Psychiatry, vol. 7, no. 3, 2002, pp. 254-75.
Gold PW, Chrousos GP. Organization of the stress system and its dysregulation in melancholic and atypical depression: high vs low CRH/NE states. Mol Psychiatry. 2002;7(3):254-75.
Gold, P. W., & Chrousos, G. P. (2002). Organization of the stress system and its dysregulation in melancholic and atypical depression: high vs low CRH/NE states. Molecular Psychiatry, 7(3), 254-75.
Gold PW, Chrousos GP. Organization of the Stress System and Its Dysregulation in Melancholic and Atypical Depression: High Vs Low CRH/NE States. Mol Psychiatry. 2002;7(3):254-75. PubMed PMID: 11920153.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Organization of the stress system and its dysregulation in melancholic and atypical depression: high vs low CRH/NE states. AU - Gold,P W, AU - Chrousos,G P, PY - 2001/10/16/received PY - 2001/10/17/accepted PY - 2002/3/29/pubmed PY - 2002/7/31/medline PY - 2002/3/29/entrez SP - 254 EP - 75 JF - Molecular psychiatry JO - Mol Psychiatry VL - 7 IS - 3 N2 - Stress precipitates depression and alters its natural history. Major depression and the stress response share similar phenomena, mediators and circuitries. Thus, many of the features of major depression potentially reflect dysregulations of the stress response. The stress response itself consists of alterations in levels of anxiety, a loss of cognitive and affective flexibility, activation of the hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system, and inhibition of vegetative processes that are likely to impede survival during a life-threatening situation (eg sleep, sexual activity, and endocrine programs for growth and reproduction). Because depression is a heterogeneous illness, we studied two diagnostic subtypes, melancholic and atypical depression. In melancholia, the stress response seems hyperactive, and patients are anxious, dread the future, lose responsiveness to the environment, have insomnia, lose their appetite, and a diurnal variation with depression at its worst in the morning. They also have an activated CRH system and may have diminished activities of the growth hormone and reproductive axes. Patients with atypical depression present with a syndrome that seems the antithesis of melancholia. They are lethargic, fatigued, hyperphagic, hypersomnic, reactive to the environment, and show diurnal variation of depression that is at its best in the morning. In contrast to melancholia, we have advanced several lines of evidence of a down-regulated hypothalamic-pituitary adrenal axis and CRH deficiency in atypical depression, and our data show us that these are of central origin. Given the diversity of effects exerted by CRH and cortisol, the differences in melancholic and atypical depression suggest that studies of depression should examine each subtype separately. In the present paper, we shall first review the mediators and circuitries of the stress system to lay the groundwork for placing in context physiologic and structural alterations in depression that may occur as part of stress system dysfunction. SN - 1359-4184 UR - https://www.unboundmedicine.com/medline/citation/11920153/Organization_of_the_stress_system_and_its_dysregulation_in_melancholic_and_atypical_depression:_high_vs_low_CRH/NE_states_ L2 - https://doi.org/10.1038/sj.mp.4001032 DB - PRIME DP - Unbound Medicine ER -