title: Evaluation of a salivary based combined dexamethasone/CRH test in patients with major depression.
abstract: The combined dexamethasone/corticotropin releasing hormone (Dex/CRH) test is one of the most reliable neuroendocrine function tests for investigation of hypothalamic-pituitary-adrenocortical (HPA) system dysregulation in depression. Persistent high HPA system activity reflected by an enhanced cortisol secretion during the Dex/CRH test after successful antidepressant treatment is correlated with an enhanced risk for relapse in remitted depressives. Thus, the Dex/CRH test might be a useful neuroendocrinological tool for treatment monitoring. However, the performance of the test requiring multiple blood samplings renders this test difficult for routine clinical use. Thus, a simplified test procedure using a saliva based test without the necessity of multiple blood samplings would be desirable.Therefore, we compared matched saliva and serum probes of Dex/CRH tests of 73 depressed patients who underwent a total of 157 tests. Both saliva and serum cortisol concentrations showed a significant stimulation pattern during the test and were highly correlated. This correlation was not influenced by either antidepressive treatment. In patients with high cortisol secretion patterns during the Dex/CRH test there was a decrease in HPA system activity after successful antidepressant treatment that was reflected by both the saliva and the serum Dex/CRH test.Thus, the saliva based combined Dex/CRH test appears to be a suitable tool for monitoring HPA system activity during the course of depressive illness. The easier performance of the saliva Dex/CRH test in comparison to the standard test procedure for both patients and hospital staff opens the door for routine clinical use of the Dex/CRH test for treatment monitoring and estimation of relapse risk.
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University of Munich, Nussbaumstrasse 7, D-80336 Munich, Germany. baghai@psy.med.uni-muenchen.de
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Baghai
authors.forename: Cornelius
authors.initials: C
authors.lastname: Schüle
authors.forename: Peter
authors.initials: P
authors.lastname: Zwanzger
authors.forename: Christo
authors.initials: C
authors.lastname: Minov
authors.forename: Christina
authors.initials: C
authors.lastname: Holme
authors.forename: Frank
authors.initials: F
authors.lastname: Padberg
authors.forename: Martin
authors.initials: M
authors.lastname: Bidlingmaier
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Strasburger
authors.forename: Rainer
authors.initials: R
authors.lastname: Rupprecht
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D003346:Corticotropin-Releasing Hormone; D003865:Major Depressive Disorder / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D003907:Dexamethasone; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D008875:Middle Aged; D012463:Saliva / Q000378:metabolism; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D003907:Dexamethasone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone