Up from Depression

The Danish theologian-philosopher Soeren Kierkegaard called despair "the sickness unto death." His description also applies to the severe psychiatric illnesses once labeled melancholia by Freud. These are not the down moods that plague everyone occasionally, but immobilizing and devastating conditions that often cause physical signs and symptoms like loss of appetite and weight, insomnia and slowness of body movement.

Psychiatrists have long suspected that there is a physiological basis for severe depression. They know that thyrotropin-releasing hormone (TRH), a substance released by the hypothalamus at the base of the brain, triggers the production of thyroid-stimulating hormone (TSH); now, they hypothesize that it may have another function as well. Drs. Arthur Prange Jr. and Ian Wilson of the University of North Carolina School of Medicine and the North Carolina department of mental health have found that TRH, which can be synthesized in the laboratory, seems to function as an antidepressant. They have used it experimentally to provide apparently safe relief to patients suffering from severe depression.

Short-Term Lift. Their findings, reported at a medical meeting in Copenhagen, grew out of studies of TRH's pharmacological effects on laboratory animals. When these experiments showed no apparent side effects from the substance, the team administered it to 18 women suffering from severe depression. In a preliminary test at Dorothea Dix Hospital in Raleigh, N.C., eight of the women who received a single injection of TRH experienced prompt, though in all cases, short-term improvement.

In subsequent studies, also at Dorothea Dix Hospital, ten other women responded equivocally to saline injections, but favorably to TRH when the two were administered in alternate sequence over a two-week period; no other medication was administered. Other experiments conducted independently reinforce those of Prange and Wilson. A team of researchers headed by Drs. Abba Kastin and Rudolph Ehrensing at the Veterans Administration Hospital in New Orleans reported in Lancet that its members administered TRH to five patients. All experienced relief from depression to some degree, and in at least two cases the improvement was marked.

The researchers cannot fully explain why TRH works. The preliminary results have been so encouraging, however, that further investigation is demanded. Most drugs now used to relieve the symptoms of depression can produce undesirable side effects. TRH so far has produced none.

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