Dysthymic Disorder and Adrenals

[Minimal Resent]

I came across a post that is very interesting in which Dr. Marianco responded with :

Dysthymia is a mild chronic depressive state, where a person never regains a normal mood.
It lasts at least 2 years (an arbitrary length of time to allow it to be distinguished from major depressive disorder or adjustment disorders).
It can be attributed to psychological, stress, and/or physical health problems.

Thus, dysthymia may occur in neurotransmitter and hormone problems.
This includes conditions with one OR more of the following (oversimplified descriptions):
1. Low Serotonin
2. Low Dopamine
3. Low Norepinephrine or high Norepinephrine
4. Low Testosterone
5. Low Estrogen
6. Low DHEA
7. Low Cortisol
8. Low Progesterone
9. Low Thyroid
10. High Insulin
11. etc. etc.

And from what I understand, Dysthymic Disorder (and PTSD) share a vast amount of similarities by that Dysthymia seems to be more induced by stress than the other depressive spectrum as it bears similarity to PTSD. One of the end results to this is low dopaminergic tone over a long period of time primarily in the mesolimbic pathway.

A simple search on pubmed revealed this:

BACKGROUND: Depressive symptomatology has been connected with an activation of the hypothalamus-pituitary-adrenal axis and, in several studies, with reduced androgen levels, while administration of androgens, usually in older subjects, may have positive effects on mood, both in males and females. Regarding dysthymic disorder (DD), low serum testosterone levels have been reported in older males, while information on younger male or on female patients is lacking. METHODS: We assessed the serum levels of testosterone (T), dehydroepiandrosterone sulfate (DHEAS) and cortisol in male and female patients with DD, and compared them to the levels of sex and age matched controls. Eighteen male and 43 female patients in the age range of 22 to 71 years were studied and diagnosed according to the Scheduled Diagnostic Interview for DSM-IV axis I disorders (SCID). Depressive symptomatology was assessed using the Hamilton Depression Rating Scale. Subgroups with subjects below or over 50 years of age were also built and compared. RESULTS: Serum T levels were lower than controls mainly in the subjects aged below 50 years, in both genders. More pronounced were reductions in DHEAS levels both in male and female patients, while cortisol levels were normal or reduced. T levels were positively correlated to both DHEAS and cortisol. The negative correlations of DHEAS and T to age were significant for all groups and subgroups, except in the group of male patients. Four male patients (22%) had T levels below 2.0 ng/ml. CONCLUSIONS: Male and female patients with DD aged below 50 years show reduced gonadal and adrenal androgen levels, and normal to low cortisol levels. These neuroendocrine characteristics differentiate DD from depression, and place this diagnostic group closer to posttraumatic stress disorder.

I am not sure if he is still around, but can anyone possibly elaborate even more on this, specifically the adrenals?

For that matter, what would be the most efficacious way of treating this? From the looks of this study there would be an extensive treatment plan necessary.