The relationships of longitudinal biological measures to longer-term outcome in depressed patients have not been well explored. This study was designed to investigate whether in a sample of depressed patients: (a) symptomatic and functional outcome at 1 year was significantly different in psychotic major depressed (PMD) patients as compared with nonpsychotic major depressed (NPMD) patients and (b) high urinary or plasma cortisol levels at baseline or 1 year were associated with poorer outcomes at 1 year. Forty-two depressed patients (9 psychotic, 33 nonpsychotic) were evaluated at baseline and at 1 year using a battery of clinical ratings and measures of cortisol. A group of normal, healthy control subjects were similarly evaluated at baseline. At 1-year follow-up, PMD patients did not differ from NPMD patients in their Hamilton Depression Rating Scale (HDRS) and Brief Psychiatric Rating Scale scores (BPRS), but PMD patients demonstrated significantly poorer social and occupational functioning. Significant correlations were observed (n = 18) between higher levels of urinary and plasma cortisol at 1 year and poorer social and occupational functioning at 1 year, independent of the degree of residual depression. In contrast, baseline measures of urinary and plasma cortisol did not predict social and occupational functioning at 1 year.

In this report, data are presented on pre- and postdexamethasone cortisol levels, neuropsychological testing, and computed tomography (CT) scan findings in 30 depressed patients (15 psychotic and 15 nonpsychotic). Particularly significant findings were observed when data from the unipolar subgroup (n = 22) were analyzed separately. Unipolar psychotic depressed patients had significantly larger (p less than 0.05) anterior pole and cella media ventricle-to-brain ratios (VBRs) and significantly greater (p less than 0.05) left and right inferior parietal brain "atrophy" than nonpsychotic depressed patients. Higher rates of Dexamethasone Suppression Test (DST) nonsuppression were observed in psychotic depressed patients and in patients with larger cella VBRs. Inferior parietal brain atrophy and large VBRs were also associated with greater cognitive impairment on psychometric testing. Implications of these findings are discussed.