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Chronic Imipramine Is Associated with Diminished Hypothalamic-Pituitary-Adrenal Axis Responsivity in Healthy Humans

Clinical Neuroendocrinology Branch (D.E., E.G., L.H., M.D., P.G.), National Institute of Mental Health; Developmental Endocrinology Branch (G.C.), National Institute of Child Health and Development, Bethesda, Maryland

Address correspondence and requests for reprints to: David Michelson, M.D., Eli Lilly and Company, Lilly Corporate Center 1046, Indianapolis, Indiana 46285. email: dmichelson@lilly.com

The hypercortisolism of melancholic depression is thought to reflect hypothalamic hypersecretion of CRH and may be related to the hyperarousal associated with this syndrome. Although chronic administration of imipramine to experimental animals significantly decreases CRH messenger RNA levels in the paraventricular nucleus, it is generally thought that resolution of hypercortisolism following recovery from depression is related to the improvement in mood and decrease in anxiety that accompanies recovery rather than an intrinsic effect of imipramine. The present study was designed to explore whether chronic imipramine administration to healthy, nondepressed volunteers is associated with effects on hypothalamic-pituitary-adrenal (HPA) axis function. We studied basal and provocative measures of HPA axis function in 14 healthy volunteers before and after 6 weeks of imipramine treatment at therapeutic doses. Imipramine was associated with decreased responses in peak ACTH and cortisol to ovine CRH and in peak ACTH to arginine vasopressin (P = 0.02, P = 0.003, and P = 0.02, respectively) without changes in indices of basal HPA axis function. These data are consistent with preclinical findings and support the hypothesis that imipramine has an intrinsic effect on central components of HPA axis function, potentially related to its therapeutic effects.

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