The combined dexamethasone-CRH test before and after repetitive transcranial magnetic stimulation (rTMS) in major depression.
BACKGROUND
Hypothalamic-pituitary-adrenocortical (HPA) dysregulation assessed by the combined dexamethasone corticotropin releasing hormone test (DEX/CRH test) has been demonstrated to normalize after successful antidepressant pharmacotherapy. Here, we investigated whether repetitive transcranial magnetic stimulation (rTMS) also leads to a normalization of HPA system activity in depressed patients.


METHODS
Thirty-seven medication free patients suffering from a major depressive episode (DSM-IV) underwent a DEX/CRH test before and after 13 daily sessions of left prefrontal rTMS in an open trial.


RESULTS
There was an overshoot of CRH-induced cortisol release that was not affected by rTMS treatment. Postdexamethasone cortisol levels prior to CRH challenge decreased in responders after rTMS treatment, whereas no change of CRH-induced adrenocorticotropic hormone (ACTH) and cortisol release in responders or nonresponders was observed.


CONCLUSIONS
The persisting HPA system hyperactivity after rTMS suggests a high risk for relapse and therefore argues for an immediate maintenance therapy in patients responding to this treatment.
Zwanzger
P
P
Department of Psychiatry, Ludwig-Maximilians-University of Munich, Nussbaumstrasse 7, Germany.
Baghai
T C
TC
Padberg
F
F
Ella
R
R
Minov
C
C
Mikhaiel
P
P
Schüle
C
C
Thoma
H
H
Rupprecht
R
R
D000328:Adult; D000368:Aged; D003346:Corticotropin-Releasing Hormone / Q000378:metabolism; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D003907:Dexamethasone / Q000378:metabolism; D004599:Electric Stimulation Therapy / Q000379:methods*; D004574:Electromagnetic Fields; D005260:Female; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D017397:Prefrontal Cortex; D012074:Remission Induction
D003907:Dexamethasone; D003346:Corticotropin-Releasing Hormone