¹Max Planck Institute of Psychiatry, Munich, Germany

Correspondence: Dr ME Keck, Current address: Division of Psychiatry Research, Psychiatric University Hospital, CH-8032 Zurich, Switzerland. Tel: +41 44 389 1477, Fax: +41 44 389 1414, E-mail: martin.keck@puk.zh.ch

²Current address: King's College, Maudsley Hospital, London, UK

³Current address: Emory University School of Medicine, Atlanta, GA 30322, USA

Received 24 March 2006; Revised 1 June 2006; Accepted 13 June 2006; Published online 12 July 2006.

Abstract

Anxiety and depressive disorders are among the most common psychiatric disorders with a high number of hospital admissions and a lifetime prevalence of up to 25%. So far, the pathophysiological mechanisms for anxiety disorders remain to be found. Preclinical studies suggest that changes in hypothalamic–pituitary–adrenocortical (HPA) system function are causally related to the expression of anxiety-related behavior. The findings on HPA system function in patients with anxiety disorders are, however, heterogeneous. Both hypo- and hyperresponsiveness of HPA response in various anxiety disorders under different experimental conditions were found. In order to characterize putative case/control differences in HPA system function, we performed a Dex-CRH test, a widely used test to pick up changes in HPA system regulation with high sensitivity, in 30 patients with panic disorder, 35 patients with major depressive episode and in 30 controls individually matched for ethnicity, age and gender. The results indicate a similar dysregulation of the HPA system response in the Dex-CRH test in both patient groups. This finding further underlines the hypothesis that both, depression and panic disorder, share impaired HPA system regulation, supporting the notion that the impairment is involved in the pathophysiology of these clinical conditions. However, differences in the suppression effects and psychopathological correlation patterns between depressed and panic patients suggest different biological mechanisms of HPA system dysregulation in both disorders.