[Treatment of major depressive disorder--method and selection of the treatment].

There are many ways of treatment for depression. Among them the most popular and effective treatment is pharmacotherapy. In the acute phase, pharmacotherapy with antidepressants, certain forms of psychotherapy, the combination of pharmacotherapy plus psychotherapy, and electroconvulsive treatment have clearly proven to be efficacious in most types of unipolar depressive disorders. The common augmenting agents probably are lithium, thyroid hormone, dopaminergic agents, and mood stabilizers. Certain treatments may be more effective in specific subtypes; for example, light therapy is useful for seasonal affective disorder. During the 16-24 weeks following remission, patients with antidepressant medications in the acute phase should be maintained on these agents to prevent relapse. For patient pharmacotherapy or psychotherapy has not been effective, the use of ECT may be useful. Following the continuation phase, maintenance-phase treatment should be considered for patients who have many depressive episodes to prevent recurrences of major depressive disorder.

Psychological, autonomic and neuroendocrine responses to acute stressors in the combined dexamethasone/CRH test: a study in healthy subjects.

The combined dexamethasone/CRH test (DEX/CRH test) is reported to produce augmented ACTH and cortisol responses in various psychiatric disorders as well as in some non-psychiatric conditions. To examine whether stress affects the outcome of DEX/CRH test, two stress groups in a repeated measures design were compared to an age-matched control group with regard to the psychological, autonomic and neuroendocrine responses after the combined dexamethasone and CRH challenge. Cold pressor (4 degrees C, total 10 min) produced stronger subjective distress than mental arithmetic (15 min). Cold exposure, but not the mental test, elevated systolic and diastolic blood pressure, whereas the mental test increased pulse rate and skin conductance level more markedly than cold exposure. Neither stressor produced a significantly enhanced response of ACTH and cortisol in DEX/CRH test, and there was no correlation between psychological and neuroendocrine responses. These findings suggest that different stressors induce different patterns of sympathetic activation and that acute stress is unlikely to affect the results of DEX/CRH test.

The differential ACTH responses to combined dexamethasone/CRH administration in major depressive and dysthymic disorders.

In a preliminary study, we performed the combined dexamethasone/CRH test on patients with major depressive and dysthymic disorders as well as healthy controls. The ACTH response was significantly enhanced in the major depression group compared to the control group and tended to be heightened compared to the dysthymia group. The cortisol response was not significantly different among the three groups. We assume that major depression and dysthymia are neuroendocrinologically distinct disorders, although whether the difference is quantitative or qualitative remains to be examined.