title: Combined DEX/CRH test among Japanese patients with major depression.
abstract: There is compelling evidence for an important role of the hypothalamus-pituitary-adrenal (HPA) axis abnormalities in the pathophysiology of major depressive disorder. Growing evidence has suggested that the combined dexamethasone (DEX)/CRH test is much more sensitive than the conventional DEX suppression test in order to detect HPA axis abnormalities. However, little data is currently available on DEX/CRH results for Asian populations, which prompted us to examine the sensitivity of the DEX/CRH test among Japanese subjects with major depression. The DEX/CRH test was administered in 20 inpatients with major depressive episode and 30 healthy controls. Significantly increased cortisol responses were observed for the patients, compared to the controls. There was a substantial difference in the distribution of non-suppressor, intermediate suppressor, and suppressor, which were defined in terms of cortisol response, was observed between the patients and controls (10, 60, and 30% in the patients vs. 0, 27, and 73% in the controls, P<0.01). Responses of ACTH showed a trend in the same direction. Within the depressed patients, individuals with a history of attempted suicide, in particular, tended to have enhanced responses to the DEX/CRH test, compared to those without such a history. Our results confirmed that the DEX/CRH test is a sensitive test to detect HPA axis abnormalities among Japanese patients with major depression. In addition, a possible relationship between suicidal acts and enhanced HPA axis abnormalities was suggested.
authors.affiliation: Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, 187-8502, Tokyo, Japan. hkunugi@ncnp.go.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kunugi
authors.forename: Takako
authors.initials: T
authors.lastname: Urushibara
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Nanko
mesh_terms: D003346:Corticotropin-Releasing Hormone; D003866:Depressive Disorder / Q000175:diagnosis* / Q000208:ethnology / Q000503:physiopathology*; D003907:Dexamethasone; D003937:Diagnosis, Differential; D005260:Female; D005938:Glucocorticoids; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000502:physiology*; D011379:Prognosis; D012680:Sensitivity and Specificity; D013406:Suicide, Attempted / Q000208:ethnology
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone; D003346:Corticotropin-Releasing Hormone