title: Fluvoxamine reduces responsiveness of HPA axis in adult female BPD patients with a history of sustained childhood abuse.
abstract: The aim of the study is to test whether fluvoxamine affects the function of the hypothalamic pituitary adrenal (HPA) axis in female borderline (borderline personality disorder, BPD) patients with and without a history of sustained childhood abuse. Special attention is given to the presence of comorbid major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). The HPA axis of 30 female BPD patients with (n = 17) and without (n = 13) a history of sustained childhood abuse was challenged with a combined dexamethasone and corticotropin releasing hormone test (DEX/CRH test) before and after 6 (n = 14) and 12 (n = 16) weeks of fluvoxamine treatment (150 mg/day). Both 6- and 12-week fluvoxamine treatments were associated with a significant and robust reduction of the adrenocorticotrophic hormone (ACTH) and cortisol response to the DEX/CRH test. The magnitude of the reduction was dependent on the presence of sustained childhood abuse, but not on the presence of comorbid MDD or PTSD: patients with a history of sustained childhood abuse showed the strongest reduction in ACTH and cortisol. In conclusion, Fluvoxamine treatment reduces the hyperresponsiveness of the HPA axis in BPD patients with a history of sustained childhood abuse. This effect is likely to be obtained in the first 6 weeks of treatment.
authors.affiliation: Leiden University Medical Center, Department of Psychiatry, Netherlands. rinne@euronet.nl
authors.forename: Thomas
authors.initials: T
authors.lastname: Rinne
authors.forename: E Ronald
authors.initials: ER
authors.lastname: de Kloet
authors.forename: Luuk
authors.initials: L
authors.lastname: Wouters
authors.forename: Jaap G
authors.initials: JG
authors.lastname: Goekoop
authors.forename: Roel H
authors.initials: RH
authors.lastname: de Rijk
authors.forename: Wim
authors.initials: W
authors.lastname: van den Brink
mesh_terms: D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000494:pharmacology*; D019540:Area Under Curve; D001883:Borderline Personality Disorder / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D002648:Child; D002649:Child Abuse / Q000523:psychology*; D003346:Corticotropin-Releasing Hormone / Q000494:pharmacology; D003866:Depressive Disorder / Q000150:complications / Q000523:psychology; D003907:Dexamethasone; D005260:Female; D016666:Fluvoxamine / Q000494:pharmacology*; D005938:Glucocorticoids; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects* / Q000503:physiopathology*; D011569:Psychiatric Status Rating Scales; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000523:psychology
chemical_list: D018687:Antidepressive Agents, Second-Generation; D005938:Glucocorticoids; D003907:Dexamethasone; D003346:Corticotropin-Releasing Hormone; D016666:Fluvoxamine