Exaggerated corticotrophic cell response to human corticotropin-releasing hormone in two patients during long-term carbamazepine treatment.
Carbamazepine, a tricyclic anticonvulsant with chemical resemblance to imipramine, has been recently successfully introduced as a prophylactic agent and acute treatment modality for manic-depressive illness (Ballenger and Post 1980; Okuma 1983; Post et al. 1984). The interest in carbamazepine emerges from its ability to dampen paroxysmal neuronal activity not only in epilepsy, but also in those particular systems that appear to be involved in the etiology of episodic affective illness (Post et al. 1983). These affective episodes are frequently associated with endocrine irregularities of the hypothalamic-pituitary-adrenocortical (HPA) axis, including increased cortisol secretion (Halbreich et al. 1985), nonsuppression of corticosteroids following dexamethasone, and blunted corticotropin (ACTH) release after stimulation with human corticotropin-releasing hormone (h-CRH) (Holsboer et al. 1986, 1987) or its heterologous ovine analog (Gold et al. 1986). Some recent reports have shown that carbamazepine treatment may interfere with HPA physiology, as it induces Dexamethasone Suppression Test (DST) nonsuppression (Privitera et al. 1982; Rubinow et al. 1984) and enhances mean urinary free cortisol secretion (Rubinow et al. 1986). To further explore the pathophysiology of this phenomenon of an altered HPA function, we conducted h-CRH tests in six patients in stable remission from major depression during long-term carbamazepine treatment to look for possibly drug-induced modulations. In two of six patients, we observed highly abnormal ACTH responses.
von Bardeleben
U
U
Department of Psychiatry, University of Mainz, F.R.G.
Wiedemann
K
K
Stalla
G K
GK
Müller
O A
OA
Holsboer
F
F
D000324:Adrenocorticotropic Hormone / Q000097:blood*; D000328:Adult; D001714:Bipolar Disorder / Q000097:blood / Q000188:drug therapy*; D002220:Carbamazepine / Q000008:administration & dosage*; D003346:Corticotropin-Releasing Hormone; D003866:Depressive Disorder / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000097:blood / Q000188:drug therapy*
D002220:Carbamazepine; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone