September 1988

Norepinephrine and Its Metabolites in Cerebrospinal Fluid, Plasma, and UrineRelationship to Hypothalamic-Pituitary-Adrenal Axis Function in Depression

Author Affiliations

From the Clinical Studies Section, Clinical Neuroscience Branch (Drs Roy and Pickar), and the Adult Psychiatry Branch (Dr Karoum), National Institute of Mental Health, and the Laboratory of Clinical Studies, Division of Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism (Drs De Jong and Linnoila), Bethesda, Md.

Arch Gen Psychiatry. 1988;45(9):849-857. doi:10.1001/archpsyc.1988.01800330081010

• Among 140 depressed and control subjects, there were significant positive correlations between indexes of noradrenergic activity in cerebrospinal fluid (CSF), plasma, and urine. Among the depressed patients, CSF levels of the norepinephrine (NE) metabolite 3-methoxy-4-hydroxyphenylglycol (MHPG) and urinary outputs of NE and its metabolites normetanephrine, MHPG, and vanillylmandelic acid correlated significantly with plasma cortisol levels in relation to dexamethasone administration. Also, CSF levels of MHPG were significantly higher among patients who were cortisol nonsuppressors than among either patients who were cortisol suppressors or controls. Urinary outputs of NE and normetanephrine were significantly higher among patients who were cortisol nonsuppressors than among controls. Patients who were cortisol suppressors had indexes of NE metabolism similar to those of controls. These results in the depressed patients extend recent observations suggesting that dysregulation of the noradrenergic system and hypothalamic-pituitary-adrenal axis occur together in a subgroup of depressed patients.