Prior studies of mood and cognitive changes produced by ACTH and glucocorticoids have not characterized accurately the incidence or time of onset of these changes. In this study mood and cognitive reactions of fifteen medical patients treated with ACTH or prednisone were studied prospectively. ACTH produced a lessening of dysphoria by the third treatment day, and mild euphoric reactions occurred in three of seven of the patients treated. Prednisone produced a reduction of dysphoria by the seventh day, but no euphoric reactions in the eight patients treated with it. Neither medical symptom improvement nor elevation of plasma cortisol levels in the patients given ACTH appeared to account for the results. The mechanism of the observed mood change remains to be elucidated.
Get full access to this article
View all access options for this article.
References
1.
GlaserG. H.RandtC. T.HoeferP. F. A., The Influence of Adrenocorticotropic Hormone (ACTH) on Central Nervous System and Neuromuscular Functions, Transactions of the American Neurological Association, 75, pp. 98–104, 1950.
2.
BormanM. C. and SchmallenbergH. C., Suicide Following Cortisone Treatment, Journal of the American Medical Association, 146, pp. 337–338, 1951.
3.
LidzT.CarterJ. D.LewisB. I., Effects of ACTH and Cortisone on Mood and Mentation, Psychosomatic Medicine, 14, pp. 363–377, 1952.
4.
BrodyS., Psychiatric Observations in Patients Treated with Cortisone and ACTH, Psychosomatic Medicine, 14, pp. 94–103, 1952.
5.
RomeH. P. and BracelandF. J., The Psychological Response to ACTH, Cortisone, Hydrocortisone, and Related Steroid Substances, American Journal of Psychiatry, 108, pp. 641–651, 1952.
6.
HollenderM. H., Psychological Reactions to Cortisone, Psychosomatic Medicine, 14, pp. 306–308, 1952.
7.
GoolkerP. and ScheinJ., Psychic Affects of ACTH and Cortisone, Psychosomatic Medicine, 15, pp. 589–613, 1953.
8.
ReesL., Psychological Concomitants of Cortisone and ACTH Therapy, Journal of Mental Science, 99, pp. 497–504, 1953.
9.
GlaserG. H., Psychotic Reactions Induced by Corticotropin (ACTH) and Cortisone, Psychosomatic Medicine, 15, pp. 280–291, 1953.
10.
FoxH. M. and GiffordS., Psychological Responses to ACTH and Cortisone, Psychosomatic Medicine, 15, pp. 614–631, 1953.
11.
CobbS.QuartonG. C., and ClarkL. D., Neuropsychiatric Disorders, in Medical Uses of Cortisone, LukinsF. (ed.), Blakeston Co., New York, pp. 506–518, 1954.
12.
FlemingerJ. J., The Differentiated Effect of Cortisone and of ACTH on Mood, Journal of Mental Science, 101, pp. 123–130, 1955.
13.
RitchieE. A., Toxic-Psychosis under Cortisone and Corticotrophin, Journal of Mental Science, 102, pp. 830–837, 1956.
14.
CobbS., Some Clinical Changes in Behavior Accompanying Endocrine Disorders, Journal of Nervous and Mental Diseases, 130, pp. 97–106, 1960.
15.
The Boston Collaborative Drug Surveillance Program: Acute Adverse Reactions to Prednisone in Relation to Dosage, Clinical Pharmacology and Therapeutics, 13, pp. 694–698, 1972.
16.
WhybrowP. C. and HurwitzT., Psychological Disturbances Associated with Endocrine Disease and Hormone Therapy, in Hormones, Behavior, and Psychopathology, SacharE. J. (ed.), Raven Press, New York, pp. 125–143, 1976.
17.
FalkW. E.MahnkeM. W., and PoskanzerD. C., Lithium Prophylaxis of Corticotropin-Induced Psychosis, Journal of the American Medical Association, 241, pp. 1011–1012, 1979.
18.
LingM. H. M.PerryP. J., and TsuangM. T., Side Effects of Corticosteroid Therapy: Psychiatric Aspects, Archives of General Psychiatry, 38, pp. 471–477, 1981.
19.
DornbushR. L.ShapiroB., and FreedmanA. M., Effects of an ACTH Short Chain Neuropeptide in Man, American Journal of Psychiatry, 38, pp. 962–964, 1981.
20.
FalkW. E., Steroid Psychosis: Diagnosis and Treatment, in Psychiatric Medicine Update, ManschreckT. C. (ed.), Elsevier, New York, pp. 147–154, 1981.
21.
CarpenterW. T. and GruenP. H., Cortisol's Effects on Human Mental Functioning, Journal of Clinical Psychopharmacology, 2, pp. 91–101, 1982.
22.
LewisD. A. and SmithR. E., Steroid-Induced Psychiatric Syndromes, Journal of Affective Disorders, 5, pp. 319–332, 1983.
23.
MillerL. H.KastinA. J.SandmanC. A., Polypeptide Influences on Attention, Memory, and Anxiety in Man, Pharmacology, Biochemistry, and Behavior, 2, pp. 663–668, 1974.
24.
SandmanC. A.GeorgeJ.WalkerB. B., Neuropeptide MSH/ACTH 4–10 Enhances Attention in the Mentally Retarded, Pharmacological and Biochemical Behavior (The Neuropeptides), 5 (Suppl 1), pp. 23–28, 1976.
25.
GaillardA. W. K. and SandersA. F., Some Effects of ACTH 4–10 on Performance during a Serial Reaction Task, Psychopharmacologia, 42, pp. 201–208, 1975.
26.
BranconnierR. J.ColeJ. O., and GardosG., ACTH 4–10 in the Amelioration of Neuropsychological Symptomatology Associated with Senile Organic Brain Syndrome, Psychopharmacology, 61, pp. 161–165, 1979.
27.
WardM. M.SandmanC. A.GeorgeJ. M., MSH/ACTH 4–10 in Men and Women: Effects upon Performance of an Attention and Memory Task, Physiology and Behavior, 22, pp. 669–673, 1979.
28.
WalkerB. B. and SandmanC. A., Influences of an Analog of the Neuropeptide ACTH 4–9 on Mentally Retarded Adults, American Journal of Mental Deficiency, 83, pp. 346–352, 1979.
29.
SandmanC. A. and WalkerB. B., An Analog of MSH/ACTH 4–9 Enhances Interpersonal and Environmental Awareness in Mentally Retarded Adults, Peptides, 1, pp. 109–114, 1980.
30.
RockstrohB.ElbertT.LutzenbergerW., Effect of an ACTH 4–9 Analog on Human Cortical Evoked Potentials in a Constant Foreperiod Reaction Time Paradigm, Psychoneuroendocrinology, 6, pp. 301–310, 1981.
31.
HoeferP. F. A. and GlaserG. H., Effects of Pituitary Adrenocorticotropic Hormone (ACTH) Therapy: Electroencephalographic and Neuropsychiatric Changes in Fifteen Patients, Journal of the American Medical Association, 143, pp. 620–624, 1950.
32.
GillinJ. C.JacobsL. S.FramD. H., Acute Effect of a Glucocorticoid on Normal Human Sleep, Nature, 237, pp. 387–399, 1972.
33.
HallR. C. W.PopkinM. K.StickneyS. K., Presentation of the Steroid Psychoses, Journal of Nervous and Mental Diseases, 167, pp. 229–236, 1979.
34.
DanielsonD. A.PorterJ. B.LawsonD. H., Drug-Associated Psychiatric Disturbances in Medical Inpatients, Psychopharmacology, 74, 105–108, 1981.
35.
HamiltonM., Development of a Rating Scale for Primary Depression, British Journal of Social and Clinical Psychology, 6, pp. 278–296, 1967.
36.
FeinbergM.CarrollB. J.SmouseP. E., The Carroll Rating Scale for Depression III, Comparison with Other Rating Instruments, British Journal of Psychiatry, 138, pp. 205–209, 1981.
37.
YoungR. C.BiggsJ. T.ZieglerV. E., A Rating Scale for Mania: Reliability, Validity, and Sensitivity, British Journal of Psychiatry, 133, pp. 429–435, 1978.
38.
KatholR. G. and PettyF., Relationship of Depression to Medical Illness, Journal of Affective Disorders, 3, pp. 111–121, 1981.
39.
StarkmanM. N.SchteingartD. E., and SchorkM. A., Depressed Mood and Other Psychiatric Manifestations of Cushing's Syndrome: Relationship to Hormone Levels, Psychosomatic Medicine, 43, pp. 3–18, 1981.
40.
FolsteinM. F.FolsteinS. F., and McHughP. R., “Mini-Mental State”: A Practical Method for Grading the Cognitive State of Patients for the Clinician, Journal of Psychiatric Research, 12, pp. 189–198, 1975.
41.
IsaacsB. and KennieA. T., The Set Test as an Aid to the Detection of Dementia in Old People, British Journal of Psychiatry, 123, pp. 467–470, 1973.
42.
KlinefelterH. F.WinkenwerderW. L., and BledsoeT., Single Daily Dose Prednisone Therapy, Journal of the American Medical Association, 241, pp. 2721–2723, 1979.
43.
StreckW. F. and LockwoodD. H., Pituitary Adrenal Recovery Following Short-Term Suppression with Corticosteroids, American Journal of Medicine, 66, pp. 910–914, 1979.
44.
MurphyB. E. P., Some Studies of the Protein Binding of Steroids and Their Application to the Routine Micro and Ultramicro Measurements of Various Steroids in Body Fluids by Competitive Protein-Binding Radioassay, Journal of Clinical Endocrinology and Metabolism, 27, pp. 973–990, 1967.
45.
BeardwellG. C.BurkeC. W., and CopeC. L., Urinary Free Cortisol Measured by Competitive Protein Binding, Journal of Endocrinology, 42, pp. 79–89, 1968.
46.
HsuT. H. and BledsoeT., Measurement of Urinary Free Corticoids by Competitive Binding Radioassay in Hypoadrenal States, Journal of Clinical Endocrinology and Metabolism, 40, pp. 443–448, 1970.
47.
WilensT. E.RitchieJ. C., and CarrollB. J., Comparison of Plasma Cortisol and Corticosterone in the Dexamethasone Suppression Test for Melancholia, Psychoneuroendocrinology, 9, pp. 45–55, 1984.
48.
CarrollB. J.FeinbergM.GredenJ. F., A Specific Laboratory Test for the Diagnosis of Melancholia, Archives of General Psychiatry, 38, pp. 15–22, 1981.
49.
CarrollB. J., Psychiatric Disorders and Steroids, in Neuroregulators and Psychiatric Disorders, UsdinE.HamburgD. A., and BarchasJ. D. (eds.), Oxford University Press, New York, pp. 276–283, 1977.
50.
JeffcoateW. J.SilverstoneJ. T.EdwardsC. R. W., Psychiatric Manifestations of Cushing's Syndrome: Response to Lowering of Plasma Cortisol, Quarterly Journal of Medicine, 48, pp. 465–472, 1979.
51.
CohenS. I., Cushing's Syndrome: A Psychiatric Study of 29 Patients, British Journal of Psychiatry, 136, pp. 120–124, 1980.
52.
KellyW. F.CheckleyS. A.BenderD. A., Cushing's Syndrome and Depression—A Prospective Study of 26 Patients, British Journal of Psychiatry, 142, pp. 16–19, 1983.
53.
DeKloetR.WallachG., and McEwenB. S., Differences in Corticosterone and Dexamethasone Binding to Rat Brain and Pituitary, Endocrinology, 96, pp. 598–609, 1975.
54.
WeindlA. and JoyntR. J., The Median Eminence as a Circumventricular Organ, in Brain-Endocrine Interaction: Median Eminence: Structure and Function, KniggeK. W.ScottD. E., and WeindlA. (eds.), Karger, Basel, pp. 280–297, 1972.
55.
KniggeK. M. and SilvermanA. J., Transport Capacity of the Median Eminence, in Brain-Endocrine Interaction: Median Eminence: Structure and Function, KniggeK. M.ScottD. E., and WeindlA. (eds.), Karger, Basel, pp. 350–363, 1972.
