Contrasting neuroendocrine responses in depression & Chronic Fatigue Syndrome (CFS)

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Hypothalamic-pituitary-adrenal (HPA) axis and central 5-HT function
were compared in chronic fatigue syndrome (CFS), depression
and healthy states. 10 patients with CFS and 15 patients with
major depression were matched for age, weight, sex and
menstrual cycle with 25 healthy controls.

Baseline-circulating cortisol levels were highest in the depressed, lowest in
the CFS and intermediate between the two in the control group (P =
0.01). Prolactin responses to the selective 5-HT-releasing
agent d-fenfluramine were lowest in the depressed, highest in
the CFS and intermediate between both in the healthy group (P
= 0.01). Matched pair analysis confirmed higher prolactin
responses in CFS patients than controls (P = 0.05) and lower
responses in depressed patients than controls (P = 0.003).
There were strong inverse correlations between prolactin and
cortisol responses and baseline cortisol values. These data
confirm that depression is associated with hypercotisolaemia
and reduced central 5-HT neurotransmission and suggest that
CFS may be associated with hypocortisolaemia and increased
5-HT function. The opposing responses in CFS and depression
may be related to reversed patterns of behavioural dysfunction
seen in these conditions. These findings attest to biological
distinctions between these disorders.

MCM: Studied 10 nondepressed CDC-criteria CFS patients, 15
with major depression (MD), and 25 healthy controls.Measured
baseline blood cortisol and prolactin and hourly levels to 5
hours after injection with the 5-hydroxytryptamine (serotonin)
agonist d-Fenfluramine.Prolactins at baseline did not differ
significantly but CFS pts rose to significantly greater levels
compared to normals whereas MD pts rose to significantly
lesser levels than normals.Cortisols at baseline were
significantly lower inCFS pts and significantly higher in
MD.After the injection, cortisol levels in CFS remained
significantly lower compared to normals whereas in MD pts,
cortisol levels remained significantly higher compared to
normals."The opposing responses in CFS and depression may be
related to reversed patterns of behavioral dysfunction seen in
these conditions.These findings attest to biological
differences between these disorders."

Cleare AJ, Bearn J, Allain T, McGregor A, Wessely S, Murray RM,
O'Keane V

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