*Paolo Pini Psychiatric Hospital, 20161 Milan, Italy; ** Department of Psychiatry, University of Milan Medical School, 20161 Milan, Italy; t Institute of Obstetrics and Gynecology, University of Modena, 41100 Modena, Italy
In previous studies we observed that patients with Primary Affective Disorders (PAD), according to RDC (26), or Major Affective Disorders (MAD), according to DSM-III (1), responded to thyrotropin-releasing hormone (TRH) adminis­tration with abnormal rises of growth hormone (GH), follicle-stimulating hor­mone (FSH), luteinizing hormone (LH), and /3-endorphin ((3-EP) and jS-lipo-thropin (/3-LPH) plasma levels, and to luteinizing hormone-releasing hormone (LHRH) with rises of GH, prolactin (PRL), /3-EP, and 0-LPH (5-8). The ab­normal GH, FSH, and LH responses to TRH administration occurred not only in depression, but also in anorexia nervosa, schizophrenia and drug addiction (3,4,10,15,16,19,20,22-24,27,29-31). This would suggest that the phenomenon is not specifically related to the basic brain impairments of depression, but to still undefined alterations of neurotransmitter-neuromodulator secretory patterns in the central nervous system that may occur in various mental disorders. It has been suggested that abnormal GH response to stimulation with releasing hormones (RH) may be owing to impairments of the rest/activity cycle and of sleep architecture, which frequently occur in mental disorders (21) since they are also present in normal humans after prolonged periods of wakefulness (11,28). Severe anxiety may be another factor that can elicit hormonal alterations and may be present in several mental disorders. Patients suffering from generalized anxiety, panic disorders, or phobias have been observed to have multiple neu­roendocrine abnormalities. Higher than normal basal plasma levels of GH, PRL, adrenocorticotropic hormone (ACTH), and Cortisol, blunted thyroid-stimulating hormone (TSH) and PRL responses to TRH stimulation, blunted ACTH-cortisol responses to corticotropin-releasing hormone (CRH) stimulation, and positive Dexametha-sone Suppression Test (DST) have been reported to occur in the aforementioned psychopathologies (9,13,14,17,18,25). Lactate infusion, which induces the appearance of panic attacks exclusively in patients with panic disorder, stimulates in these subjects GH and PRL secre­tion, whereas Cortisol, /?-EP, LH, and vasopressin levels do not change or are increased slightly. GH and PRL rises never occur in control subjects under the same experimental conditions (2,12,18). We have investigated the influence of severe anxiety and sleep disorders on the responses of anterior pituitary (AP) hormones to RH stimulation in a group of subjects with anxious depression, defined, according to DSM-III, as Dysthymic Disorder. The aim of this study was to see whether the neuroendocrine alterations ob­served in PAD were present also in this subgroup of depressive disorders and to determine if their presence could be attributed to anxiety and/or reduced sleep efficiency.

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