LETTER TO THE EDITOR LONGITUDINAL STUDIES OF BIOLOGIC MARKERS FOR DEPRESSION IN MALE ANORECTICS

ONE ASPECT of the anorexia nervosa (AN) problem is its possible link with affective disorders, mainly depression, an opinion held by some authors (Gwirtsman & Gerner, 1981; Katz et al., 1984) but challenged by others (Altshuler & Weiner, 1985). Early escape of cortisol suppression in the dexamethasone suppression test (DST), blunted TSH response in the thyrotropin releasing hormone (TRH) test, and shortened REM latency (REML), encountered in endogenous depression, also have been reported in anorectic patients (Gwirtsman & Gerner, 1981; Brambilla et al., 1981; Katz et al., 1984). These studies, however, did not include administration of all three tests to the same patients; they included mainly female patients, and they were not longitudinal in design. We studied two male anorectics longitudinally by close clinical observation and by administration of all three biological tests. These patients were studied at the time of their admission to the hospital, immediately following their restoration of body weight, and 1 year later. At each of these three times, in addition to clinical evaluation and other tests (to be reported elsewhere), the patients were investigated with the DST and the TRH test, as well as with sleep recordings for determining REML. The diagnosis of AN was based on the DSM-III criteria. Severity of depression was measured with the 21-item Hamilton depression scale (HDS). Body weight fluctuations of the patients were expressed in terms of the percent of their ideal body weight (IBW), as determined by the standards of the Metropolitan Life Insurance Company of New York. The DST was performed and evaluated according to standard methodology (Carroll et al., 1981). For the TRH test, synthetic TRH (400 ~tg) was given. Blood samples were withdrawn just before the TRH infusion and 30, 60, 90, and 120 rain later. The TSH response was considered blunted when ATSH was less than 6 ~tU/ml. Finally, at each time of study, sleep laboratory recordings were obtained for three consecutive nights. The time in minutes from sleep onset to the first epoch of REM sleep was considered as REML. The mean value for the three nights is reported for each time of study.