Disordered adrenocorticotropin secretion in women with major depression.

CONTEXT Major depression is accompanied by activation of the hypothalamic pituitary axis and evidence of abnormalities in circadian and ultradian hormone rhythms. In addition, diminished negative feedback of cortisol on ACTH has been found. OBJECTIVE The objective of the study was to compare ACTH and cortisol hormonal patterns in women with major depression with normal control women. DESIGN This was a case control study. SETTING The study was conducted at a general clinical research center. PATIENTS AND OTHER PARTICIPANTS Healthy, drug-free, premenopausal women with major depression and age and menstrual cycle day-matched healthy control women were included in the study. MAIN OUTCOME MEASURE ACTH and cortisol data were measured every 10 min for 24 h analyzed with approximate entropy and cross-approximate entropy to determine orderliness of hormone secretion and relationship between ACTH and cortisol in terms of feedforward and feedback synchrony. RESULTS Depressed women manifested increased approximate entropy, indicating more disorderly secretion, of ACTH and elevated forward cross-approximate entropy of ACTH on cortisol, denoting unopposed ACTH drive. CONCLUSIONS These data support other evidence of hormonal rhythm abnormalities in depression and are compatible with accentuated feedforward drive by ACTH.