Corticotropin-releasing hormone challenge in prepubertal major depression

Boris Birmaher, Ronald E. Dahl, James Perel, Douglas E. Williamson, Beverly Nelson, Stacy Stull, Joan Kaufman, G. Scott Waterman, Uma Rao, Nga Nguyen, Joaquim Puig-Antich, Neal D. Ryan

Research output: Contribution to journalArticlepeer-review

60 Scopus citations


This study investigates cortisol and ACTH (corticotropin) responses to an infusion of human CRH (corticotropin-releasing hormone) in prepubertal children with major depressive disorder (MDD), Following a period of 24 hours of adaptation to the laboratory environment with an intravenous catheter in place, 34 children with MDD and 22 healthy controls received 1 μg/kg of human CRH at 5:00 PM. Blood samples for cortisol and ACTH were measured at baseline and post-CRH. Overall, there were no significant differences between the MDD and the normal controls in baseline or post CRH stimulation values of either cortisol or ACTH. Melancholic (n = 4) patients had significantly higher baseline cortisol levels than nonmelancholic (n = 24) patients. Compared with the outpatients and the nonmelancholics, the inpatients (n = 10) and the melancholics showed significantly lower total ACTH secretion (effect size: 0.9 and 1.4, respectively) after CRH infusion. These results are consistent with a broad literature suggesting that the HPA axis abnormalities occur less frequently in early-onset depression than reported in adult studies. The pattern of results in the subgroups of inpatients and in melancholic children, however, raise questions about possible continuities with adult studies.

Original languageEnglish (US)
Pages (from-to)267-277
Number of pages11
JournalBiological psychiatry
Issue number4
StatePublished - Feb 15 1996
Externally publishedYes


  • ACTH
  • CRH
  • Child depression
  • Cortisol
  • Stress

ASJC Scopus subject areas

  • Biological Psychiatry


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