Hypothalamus-pituitary-adrenal system regulation and suicidal behavior in depression.
BACKGROUND
One of the most demanding tasks in psychiatry is to protect patients from suicidal attempts. Preventive strategies could be improved by increasing our knowledge on the pathophysiologic disturbances underlying this behavior. More than 70-80% of suicides occur in the context of depressive disorders, in which dysregulation of the hypothalamus-pituitary-adrenal (HPA) axis is one of the most prominent neurobiological findings. So far data on the involvement of the HPA axis in the pathophysiology of suicidal behavior in depressed patients are controversial.


METHODS
In this retrospective study, we administered the combined dexamethasone-suppression/CRH stimulation (Dex/CRH) test to 310 patients with a depressive syndrome characterized at admission for acute and past suicidal behavior within the first 10 days after hospitalization.


RESULTS
Suicidal behavior in depressed patients, including past and recent suicide attempts as well as suicidal ideation, was associated with a lower adrenocorticotropin and cortisol response in the combined Dex/CRH test, with lowest hormone levels observed in patients with a recent suicide attempt.


CONCLUSIONS
The findings suggest that suicidal behavior may alter HPA axis regulation in depressed patients. Large-scale prospective studies assessing neuroendocrine changes may help to develop predictors for an early identification of patients at risk for committing suicide.
Pfennig
Andrea
A
Max-Planck Institute of Psychiatry, Munich, Germany. andrea.pfennig@charite.de
Kunzel
Heike E
HE
Kern
Nikola
N
Ising
Marcus
M
Majer
Matthias
M
Fuchs
Brigitte
B
Ernst
Gertrud
G
Holsboer
Florian
F
Binder
Elisabeth B
EB
D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D003346:Corticotropin-Releasing Hormone; D003863:Depression / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology*; D003907:Dexamethasone; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013405:Suicide / Q000523:psychology; D013997:Time Factors
D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone