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Effect of 5-Hydroxytryptophan on Serum Cortisol Levels in Major Affective Disorders: I. Enhanced Response in Depression and Mania

Effect of 5-Hydroxytryptophan on Serum Cortisol Levels in Major Affective Disorders: I. Enhanced... Abstract • The serum cortisol concentration following administration of 5-hydroxytryptophan (5-HTP), 200 mg orally, a precursor of serotonin (5-HT), was significantly greater in unmedicated depressed and manic patients than in normal controls. Increases in serum cortisol levels greater than 5 ug/dL were significantly more frequent in both unmedicated depressed and manic patients than in the normal controls. There was significant test-retest reliability. Baseline serum cortisol concentration correlated negatively with the cortisol response to 5-HTP in normal controls. These results suggest increased 5-HT receptor sensitivity may be present, possibly in the hypothalamus or pituitary, in some patients with affective disorders. These results are consistent with the hypothesis that decreased serotonergic activity, which would be expected to produce increased 5-HT receptor sensitivity, may be present in both depression and mania. References 1. Ashcroft GW, Crawford TBB, Eccleston D, Sharman DF, MacDougall EJ, Stanton JB, Binns JK: 5-Hydroxyindole compounds in the cerebrospinal fluid of patients with psychiatric or neurological diseases . Lancet 1966; 2:1049-1052.Crossref 2. Åsberg M, Thoren P, Traskman L: 'Serotonin depression'—A biochemical subgroup within the affective disorders . Science 1976;191:478-480.Crossref 3. Van Praag HM: Depression and Schizophrenia: A Contribution on Their Chemical Pathologies . New York, Spectrum Publications, 1977, pp 65-92. 4. Åsberg M, Bertilsson L: Serotonin in depressive illness: Studies of CSF 5-HIAA , in Saleto B, Berner P, Hollister LE (eds): Neuropsychopharmacology . New York, Pergamon Press, 1979, pp 105-115. 5. Cowdry RW, Goodwin FK: Amine neurotransmitter studies and psychiatric illness: Toward more meaningful diagnostic concepts , in Spitzer RL, Klein DF (eds): Critical Issues in Psychiatric Diagnosis . New York, Raven Press, 1978, pp 281-304. 6. Shaw DM, Camps FE, Eccleston EG: 5-Hydroxytryptamine in the hindbrain of depressive suicides . Br J Psychiatry 1967;113:1407-1411.Crossref 7. Bourne HR, Bunney WE, Colburn RW: Noradrenaline, 5-hydroxytryptamine and 5-hydroxyindoleacetic acid in the hindbrains of suicidal patients . Lancet 1968;2:805-808.Crossref 8. Lloyd KG, Farley IJ, Deck JHN, Horneykiewicz O: Serotonin and 5-hydroxyindoleacetic acid in discrete areas of the brainstem of suicide victims and control patients . Adv Biochem Psychopharmacol 1974;11:387-398. 9. Beskow J, Gottfries CG, Roos BE, Winblad DB: Determination of monoamine and monoamine metabolites in the human brain: Post mortem studies in a group of suicides and in a control group . Acta Psychiatr Scand 1976;53:7-20.Crossref 10. Cochran E, Robins E, Grote S: Regional serotonin levels in brain: A comparison of depressive suicides and alcoholic suicides with controls . Biol Psychiatry 1976;11:283-294. 11. Coppen A, Shaw DW, Herzberg B, Maggs R: Tryptophan in the treatment of depression . Lancet 1967;2:1178-1180.Crossref 12. Carroll BJ: Monoamine precursors in the treatment of depression . Clin Pharmacol Ther 1971;12:743-761. 13. Walinder J, Skott A, Carlsson A, Nagy A, Roos B-E: Potentiation of the antidepressant action of clomipramine by tryptophan . Arch Gen Psychiatry 1976;32:1384-1389.Crossref 14. Van Praag HM, van Korf J: 5-Hydroxytryptophan as an antidepressant: The predictive value of the probenecid test . J Nerv Ment Dis 1974;158:331-337.Crossref 15. Kaneko M, Kumashiro H, Takahashi Y, Hoshino Y: L-5-HTP treatment and serum 5-HT level after L-5-HTP loading in depressed patients . Neuropsychobiology 1979;5:232-240.Crossref 16. Murphy DL, Campbell I, Costa JL: Current studies of the indoleamine hypothesis of the affective disorders , in Lipton MA, DiMascio A, Killam KF (eds): Psychopharmacology: A Generation of Progress . New York, Raven Press, 1978, pp 1235-1248. 17. Shopsin B, Friedman E, Gershon S: Parachlorophenylalanine reversal of tranylcypromine effect in depressed patients . Arch Gen Psychiatry 1976;33:811-822.Crossref 18. Bowers MB: Lumbar CSF 5-hydroxyindoleacetic acid and homovanillac acid in affective syndromes . J Nerv Ment Dis 1974;158:325-330.Crossref 19. Mendels J, Stinnett JL, Burns D: Amine precursors and depression . Arch Gen Psychiatry 1975;32:22-30.Crossref 20. Tuomisto J, Tukiainen E, Ahlfors UG: Decreased uptake of 5-hydroxytryptamine in blood platelets from patients with endogenous depression . Psychopharmacology 1979;65:141-147.Crossref 21. Meltzer HY, Arora RC, Baber R, Tricou BJ: Serotonin uptake in blood platelets of psychiatric patients . Arch Gen Psychiatry 1981;38:1322-1326.Crossref 22. Briley MS, Langer SZ, Raisman R, Sechter D, Zarifran E: 3H-imipramine binding sites are decreased in platelets of untreated depressed patients . Science 1980;209:303-305.Crossref 23. Paul SM, Rehavi M, Skolnick F, Goodwin FP: Demonstration of specific 'high affinity' binding sites for 3H imipramine on human platelets . Life Sci 1980;26:953-959.Crossref 24. Stanley M, Viggilio J, Gershon S: Tritiated imipramine binding sites are decreased in the frontal cortex of suicides . Science 1982;216:1337-1339.Crossref 25. Stanley M, Mann J: Increased serotonin-2 binding sites in frontal cortex of suicide victims . Lancet 1983;1:214-216.Crossref 26. Dencker SJ, Malm U, Roos B-E, Wendinius B: Acid monoamine metabolites of cerebrospinal fluid in mental depression and mania . J Neurochem 1966;13:1545-1548.Crossref 27. Bowers MB, Heninger G: Lithium: Clinical effects and cerebrospinal fluid acid monoamine metabolites . Comm Psychopharmacol 1977;1:135-145. 28. Coppen A, Prange AJ, Hill C, Whybhow PC, Noguera R: Abnormalities of indoleamines in affective disorders . Arch Gen Psychiatry 1972;26:474-478.Crossref 29. Prange AJ, Wilson IC, Lynn CW, Alltop LB, Stikeleather RA: L-tryptophan in mania: Contribution to a permissive hypothesis of affective disorders . Arch Gen Psychiatry 1974;30:56-62.Crossref 30. Meltzer HY, Wiita B, Tricou BJ, Simonovic M, Fang VS: Effect of serotonin precursors and serotonin agonists on plasma hormone levels . Adv Biochem Psychopharmacol 1982;34:117-140. 31. Naumenko EV: Effect of local injection of 5-hydroxytryptamine into rhinencephalic and mesencephalic structures on pituitary-adrenal function in guinea pigs . Neuroendocrinology 1969;5:81-88.Crossref 32. Fuller RW: Serotonergic stimulation of pituitary-adrenocortical function in rats . Neuroendocrinology 1981;32:118-127.Crossref 33. Imura H, Nakai Y, Yoshimi T: Effect of 5-hydroxytryptophan (5-HTP) on growth hormone and ACTH release in man . J Clin Endocrinol Metabol 1973;36:204-206.Crossref 34. Van Loon GR: Brain catecholamines and ACTH secretion , in Ganong WF, Martini L (eds): Frontiers in Neuroendocrinology . New York, Oxford University Press Inc, 1973, vol 3, pp 209-248. 35. Meltzer HY, Simonovic M, Ravitz AJ, Fang VS, Goode DJ: Effect of psychotomimetic drugs on rat and human prolactin and growth hormone levels , in Beumont PJV, Burrow GD (eds): Handbook of Psychiatry and Endocrinology . New York, Elsevier/North-Holland Inc, 1982, pp 215-238. 36. Parati EA, Zanardi P, Cocchi D, Caraconi T, Muller EE: Neuroendocrine effects of quipazine in man in health state or with neurological disorders . J Neural Transm 1980;47:273-297.Crossref 37. Mashchak CA, Kletzky DA, Spencer C, Antal R: Transient effect of L-5-hydroxytryptophan on pituitary function in men and women . J Endocrinol Metabol 1983;56:170-176.Crossref 38. Meltzer HY, Perline R, Tricou BJ, Lowy M, Robertson A: Effect of 5-hydroxytryptophan on serum cortisol levels in major affective disorders: II. Relation to suicide, psychosis, and depressive symptoms . Arch Gen Psychiatry 1984;41:379-387.Crossref 39. Meltzer HY, Lowy M, Robertson A, Goodnick P, Perline R: Effect of 5-hydroxytryptophan on serum cortisol levels in major affective disorders: III. Effect of antidepressants and lithium carbonate . Arch Gen Psychiatry 1984;41:391-397.Crossref 40. Wing JK, Cooper JE, Sartorius N, et al: The Measurement and Classification of Psychiatric Symptoms . London, Cambridge University Press, 1974, pp 237-244. 41. Endicott J, Spitzer R: A diagnostic interview: A schedule for affective disorders and schizophrenia . Arch Gen Psychiatry 1978;35:837-844.Crossref 42. Hamilton M: A rating scale for depression . J Neurol Neurosurg Psychiatry 1960;23:56-62.Crossref 43. Spitzer RL, Endicott J, Robins E: Research Diagnostic Criteria: Rationale and reliability . Arch Gen Psychiatry 1978;35:773-782.Crossref 44. Meltzer HY, Fang VS: Cortisol determination and the dexamethasone suppression test: A review . Arch Gen Psychiatry 1983;40:501-505.Crossref 45. Westenberg HGM, van Praag HM, de Jong JTVM, Thissen JHH: Post-synaptic serotonergic activity in depressive patients: Evaluation of the neuroendocrine strategy . Psychiatry Res 1982;7:361-371.Crossref 46. Lichtensteiger W, Mutzner U, Langemann H: Uptake of 5-hydroxytryptamine and 5-hydroxytryptophan by neurons of the central nervous system normally containing catecholamines . J Neurochem 1967;14:489-497.Crossref 47. Fuxe K, Butcher LL, Engel J: DL-5-hydroxytryptophan-induced changes in central monoamine neurons after peripheral decarboxylase inhibition . J Pharm Pharmacol 1971;23:420-424.Crossref 48. Ng KY, Chase TN, Colburn RW, Kopin IJ: L-dopa-induced release of cerebral monoamines . Science 1970;170:76-77.Crossref 49. Everett GM, Borcherdring JW: L-Dopa: Effect on concentration of dopamine, norepinephrie and serotonin in brains of mice . Science 1970;168:849-850.Crossref 50. Schlesberg AJ, Harvey AJ: Effects of L-Dopa and L-5-hydroxytryptophan on locomotor activity of the rat after selective or combined destruction of central catecholamine and serotonin neurons . J Pharmacol Exp Ther 1979;211:296-304. 51. Meltzer HY, Busch D, Fang VS: Hormones, dopamine receptors and schizophrenia . Psychoneuroendocrinology 1981;6:17-36.Crossref 52. Jones MT, Hillhouse EW, Burden J: Effect of various putative neurotransmitters on the secretion of corticotrophin-releasing hormone from the rat hypothalamus in vitro: A model of the neurotransmitters involved . J Endocrinol 1976;69:1-10.Crossref 53. Spinedi E, Negro-Villar A: Serotonin and adrenocorticotropin (ACTH) release: Direct effects at the anterior pituitary level and potentiation of arginine-vasopressin-induced ACTH release . 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Szafarczyk A, Ixart G, Malaval F, Nouguier-Soulé J, Assenmacher I: Effects of lesions of the suprachiasmatic nuclei and of p-chlorophenylalanine on the circadian rhythms of adrenocorticotrophic hormone and corticosterone in the plasma, and on locomotor activity of rats . J Endocrinol 1979; 83:1-16.Crossref 60. Honma K-I, Watanabe K, Kiroshige T: Effects of parachlorophenylalanine and 5,6-D, hydroxytryptamine on the free-running rhythms of locomotor activity and plasma corticosterone in the rat exposed to continuous light . Brain Res 1979;169:531-544.Crossref 61. Amar A, Mandel S, Sanyal AK: Effect of brain monoamines on the secretion of adrenocorticotrophic hormone . Acta Endocrinol 1982;101:180-186. 62. Krieger DT, Amorosa L, Linick F: Cyproheptadine-induced remission of Cushing's disease . N Engl J Med 1975;293:893-896.Crossref 63. Krieger DT, Luria M: Effectiveness of cyproheptadine in decreasing plasma ACTH concentrations in Nelson's syndrome . J Clin Endocrinol Metabol 1976;43:1179-1182.Crossref 64. Lamberts SWJ, Bons EG, Vitterlinden P, Hackeng WH: Cyproheptadine and des-methylcyproheptadine directly inhibit the release of adrenocorticotrophin and β-lipotrophin/β-endorphin activity from the neurointermediate lobe of the rat pituitary gland . J Endocrinol 1983;96:395-400.Crossref 65. Scapagnini U, Moberg GP, van Loon GR, Ganong WF: Relation of brain 5-hydroxytryptamine content to the diurnal variation in plasma corticosterone in the rat . Neuroendocrinology 1971;7:90-96.Crossref 66. Vernikos-Danellis J, Berger P, Barchas JD: Brain serotonin and pituitary adrenal function . Rec Prog Brain Res 1973;39:301-308. 67. Van Delft AML, Kaplanski J, Smelik PG: Circadian periodicity of pituitary-adrenal function after p-chlorophenylalanine administration in the rat . J Endocrinol 1973;59:465-474.Crossref 68. Sachar EJ, Hellman HP, Roffwarg FS, Halpern FS, Fukushima DK, Gallagher TF: Disrupted 24-hour patterns of cortisol secretion in psychotic depression . Arch Gen Psychiatry 1973;28:19-24.Crossref 69. Balestrery FG, Moberg GP: Effect of midbrain raphe nuclei lesions on the circadian rhythm of plasma corticosterone in the rat . Brain Res 1976;118:503-508.Crossref 70. Rotsztejn W, Beaudit A, Roberge AG: Role of brain serotonin in the circadian rhythm of corticosterone secretion and the corticotrophic response to adrenalectomy in the rat . Neuroendocrinology 1977;23:157-170.Crossref 71. Vermes I, Telegdy G: Effect of intraventricular injection and intrahypothalamic implementation of serotonin on the hypothalamohypophysealadrenal system in the rat . Acta Physiol Acad Sci Hung 1972;42:49-59. 72. Berger PA, Barchas JD, Bernikos-Danellis J: Serotonin and pituitary-adrenal function . Nature 1974;248:424-426.Crossref 73. 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Effect of 5-Hydroxytryptophan on Serum Cortisol Levels in Major Affective Disorders: I. Enhanced Response in Depression and Mania

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References (100)

Publisher
American Medical Association
Copyright
Copyright © 1984 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1984.01790150056009
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Abstract

Abstract • The serum cortisol concentration following administration of 5-hydroxytryptophan (5-HTP), 200 mg orally, a precursor of serotonin (5-HT), was significantly greater in unmedicated depressed and manic patients than in normal controls. Increases in serum cortisol levels greater than 5 ug/dL were significantly more frequent in both unmedicated depressed and manic patients than in the normal controls. There was significant test-retest reliability. Baseline serum cortisol concentration correlated negatively with the cortisol response to 5-HTP in normal controls. These results suggest increased 5-HT receptor sensitivity may be present, possibly in the hypothalamus or pituitary, in some patients with affective disorders. These results are consistent with the hypothesis that decreased serotonergic activity, which would be expected to produce increased 5-HT receptor sensitivity, may be present in both depression and mania. References 1. Ashcroft GW, Crawford TBB, Eccleston D, Sharman DF, MacDougall EJ, Stanton JB, Binns JK: 5-Hydroxyindole compounds in the cerebrospinal fluid of patients with psychiatric or neurological diseases . Lancet 1966; 2:1049-1052.Crossref 2. Åsberg M, Thoren P, Traskman L: 'Serotonin depression'—A biochemical subgroup within the affective disorders . Science 1976;191:478-480.Crossref 3. Van Praag HM: Depression and Schizophrenia: A Contribution on Their Chemical Pathologies . New York, Spectrum Publications, 1977, pp 65-92. 4. Åsberg M, Bertilsson L: Serotonin in depressive illness: Studies of CSF 5-HIAA , in Saleto B, Berner P, Hollister LE (eds): Neuropsychopharmacology . New York, Pergamon Press, 1979, pp 105-115. 5. Cowdry RW, Goodwin FK: Amine neurotransmitter studies and psychiatric illness: Toward more meaningful diagnostic concepts , in Spitzer RL, Klein DF (eds): Critical Issues in Psychiatric Diagnosis . New York, Raven Press, 1978, pp 281-304. 6. Shaw DM, Camps FE, Eccleston EG: 5-Hydroxytryptamine in the hindbrain of depressive suicides . Br J Psychiatry 1967;113:1407-1411.Crossref 7. Bourne HR, Bunney WE, Colburn RW: Noradrenaline, 5-hydroxytryptamine and 5-hydroxyindoleacetic acid in the hindbrains of suicidal patients . Lancet 1968;2:805-808.Crossref 8. Lloyd KG, Farley IJ, Deck JHN, Horneykiewicz O: Serotonin and 5-hydroxyindoleacetic acid in discrete areas of the brainstem of suicide victims and control patients . Adv Biochem Psychopharmacol 1974;11:387-398. 9. Beskow J, Gottfries CG, Roos BE, Winblad DB: Determination of monoamine and monoamine metabolites in the human brain: Post mortem studies in a group of suicides and in a control group . Acta Psychiatr Scand 1976;53:7-20.Crossref 10. Cochran E, Robins E, Grote S: Regional serotonin levels in brain: A comparison of depressive suicides and alcoholic suicides with controls . Biol Psychiatry 1976;11:283-294. 11. Coppen A, Shaw DW, Herzberg B, Maggs R: Tryptophan in the treatment of depression . Lancet 1967;2:1178-1180.Crossref 12. Carroll BJ: Monoamine precursors in the treatment of depression . Clin Pharmacol Ther 1971;12:743-761. 13. Walinder J, Skott A, Carlsson A, Nagy A, Roos B-E: Potentiation of the antidepressant action of clomipramine by tryptophan . Arch Gen Psychiatry 1976;32:1384-1389.Crossref 14. Van Praag HM, van Korf J: 5-Hydroxytryptophan as an antidepressant: The predictive value of the probenecid test . J Nerv Ment Dis 1974;158:331-337.Crossref 15. Kaneko M, Kumashiro H, Takahashi Y, Hoshino Y: L-5-HTP treatment and serum 5-HT level after L-5-HTP loading in depressed patients . Neuropsychobiology 1979;5:232-240.Crossref 16. Murphy DL, Campbell I, Costa JL: Current studies of the indoleamine hypothesis of the affective disorders , in Lipton MA, DiMascio A, Killam KF (eds): Psychopharmacology: A Generation of Progress . New York, Raven Press, 1978, pp 1235-1248. 17. Shopsin B, Friedman E, Gershon S: Parachlorophenylalanine reversal of tranylcypromine effect in depressed patients . Arch Gen Psychiatry 1976;33:811-822.Crossref 18. Bowers MB: Lumbar CSF 5-hydroxyindoleacetic acid and homovanillac acid in affective syndromes . J Nerv Ment Dis 1974;158:325-330.Crossref 19. Mendels J, Stinnett JL, Burns D: Amine precursors and depression . Arch Gen Psychiatry 1975;32:22-30.Crossref 20. Tuomisto J, Tukiainen E, Ahlfors UG: Decreased uptake of 5-hydroxytryptamine in blood platelets from patients with endogenous depression . Psychopharmacology 1979;65:141-147.Crossref 21. Meltzer HY, Arora RC, Baber R, Tricou BJ: Serotonin uptake in blood platelets of psychiatric patients . Arch Gen Psychiatry 1981;38:1322-1326.Crossref 22. Briley MS, Langer SZ, Raisman R, Sechter D, Zarifran E: 3H-imipramine binding sites are decreased in platelets of untreated depressed patients . Science 1980;209:303-305.Crossref 23. Paul SM, Rehavi M, Skolnick F, Goodwin FP: Demonstration of specific 'high affinity' binding sites for 3H imipramine on human platelets . Life Sci 1980;26:953-959.Crossref 24. Stanley M, Viggilio J, Gershon S: Tritiated imipramine binding sites are decreased in the frontal cortex of suicides . Science 1982;216:1337-1339.Crossref 25. Stanley M, Mann J: Increased serotonin-2 binding sites in frontal cortex of suicide victims . Lancet 1983;1:214-216.Crossref 26. Dencker SJ, Malm U, Roos B-E, Wendinius B: Acid monoamine metabolites of cerebrospinal fluid in mental depression and mania . J Neurochem 1966;13:1545-1548.Crossref 27. Bowers MB, Heninger G: Lithium: Clinical effects and cerebrospinal fluid acid monoamine metabolites . Comm Psychopharmacol 1977;1:135-145. 28. Coppen A, Prange AJ, Hill C, Whybhow PC, Noguera R: Abnormalities of indoleamines in affective disorders . Arch Gen Psychiatry 1972;26:474-478.Crossref 29. Prange AJ, Wilson IC, Lynn CW, Alltop LB, Stikeleather RA: L-tryptophan in mania: Contribution to a permissive hypothesis of affective disorders . Arch Gen Psychiatry 1974;30:56-62.Crossref 30. Meltzer HY, Wiita B, Tricou BJ, Simonovic M, Fang VS: Effect of serotonin precursors and serotonin agonists on plasma hormone levels . Adv Biochem Psychopharmacol 1982;34:117-140. 31. Naumenko EV: Effect of local injection of 5-hydroxytryptamine into rhinencephalic and mesencephalic structures on pituitary-adrenal function in guinea pigs . Neuroendocrinology 1969;5:81-88.Crossref 32. Fuller RW: Serotonergic stimulation of pituitary-adrenocortical function in rats . Neuroendocrinology 1981;32:118-127.Crossref 33. Imura H, Nakai Y, Yoshimi T: Effect of 5-hydroxytryptophan (5-HTP) on growth hormone and ACTH release in man . J Clin Endocrinol Metabol 1973;36:204-206.Crossref 34. Van Loon GR: Brain catecholamines and ACTH secretion , in Ganong WF, Martini L (eds): Frontiers in Neuroendocrinology . New York, Oxford University Press Inc, 1973, vol 3, pp 209-248. 35. Meltzer HY, Simonovic M, Ravitz AJ, Fang VS, Goode DJ: Effect of psychotomimetic drugs on rat and human prolactin and growth hormone levels , in Beumont PJV, Burrow GD (eds): Handbook of Psychiatry and Endocrinology . New York, Elsevier/North-Holland Inc, 1982, pp 215-238. 36. Parati EA, Zanardi P, Cocchi D, Caraconi T, Muller EE: Neuroendocrine effects of quipazine in man in health state or with neurological disorders . J Neural Transm 1980;47:273-297.Crossref 37. Mashchak CA, Kletzky DA, Spencer C, Antal R: Transient effect of L-5-hydroxytryptophan on pituitary function in men and women . J Endocrinol Metabol 1983;56:170-176.Crossref 38. Meltzer HY, Perline R, Tricou BJ, Lowy M, Robertson A: Effect of 5-hydroxytryptophan on serum cortisol levels in major affective disorders: II. Relation to suicide, psychosis, and depressive symptoms . Arch Gen Psychiatry 1984;41:379-387.Crossref 39. Meltzer HY, Lowy M, Robertson A, Goodnick P, Perline R: Effect of 5-hydroxytryptophan on serum cortisol levels in major affective disorders: III. Effect of antidepressants and lithium carbonate . Arch Gen Psychiatry 1984;41:391-397.Crossref 40. Wing JK, Cooper JE, Sartorius N, et al: The Measurement and Classification of Psychiatric Symptoms . London, Cambridge University Press, 1974, pp 237-244. 41. Endicott J, Spitzer R: A diagnostic interview: A schedule for affective disorders and schizophrenia . Arch Gen Psychiatry 1978;35:837-844.Crossref 42. Hamilton M: A rating scale for depression . J Neurol Neurosurg Psychiatry 1960;23:56-62.Crossref 43. Spitzer RL, Endicott J, Robins E: Research Diagnostic Criteria: Rationale and reliability . Arch Gen Psychiatry 1978;35:773-782.Crossref 44. Meltzer HY, Fang VS: Cortisol determination and the dexamethasone suppression test: A review . Arch Gen Psychiatry 1983;40:501-505.Crossref 45. 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Journal

Archives of General Psychiatry – American Medical Association

Published: Apr 1, 1984

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