Assessment of the dexamethasone/CRH test as a state-dependent marker for hypothalamic-pituitary-adrenal (HPA) axis abnormalities in major depressive episode: a Multicenter Study.
There is compelling evidence for the involvement of hypothalamic-pituitary-adrenal (HPA) axis abnormalities in depression. Growing evidence has suggested that the combined dexamethasone (DEX)/corticotropin-releasing hormone (CRH) test is highly sensitive to detect HPA axis abnormalities. We organized a multicenter study to assess the DEX/CRH test as a state-dependent marker for major depressive episode in the Japanese population. We conducted the DEX/CRH test in 61 inpatients with major depressive episode (Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV)) and 57 healthy subjects. In all, 35 patients were repeatedly assessed with the DEX/CRH test on admission and before discharge. The possible relationships between clinical variables and the DEX/CRH test were also examined. Significantly enhanced pituitary-adrenocortical responses to the DEX/CRH test were observed in patients on admission compared with controls. Such abnormalities in patients were significantly reduced after treatment, particularly in those who underwent electroconvulsive therapy (ECT) in addition to pharmacotherapy. Age and female gender were associated with enhanced hormonal responses to the DEX/CRH test. Severity of depression correlated with DEX/CRH test results, although this was explained, at least in part, by a positive correlation between age and severity in our patients. Medication per se was unrelated to DEX/CRH test results. These results suggest that the DEX/CRH test is a sensitive state-dependent marker to monitor HPA axis abnormalities in major depressive episode during treatment. Restoration from HPA axis abnormalities occurred with clinical responses to treatment, particularly in depressed patients who underwent ECT.
Kunugi
Hiroshi
H
Department of Psychiatry, Teikyo University School of Medicine, Tokyo, Japan. hkunugi@ncnp.go.jp
Ida
Itsuro
I
Owashi
Toshimi
T
Kimura
Mahito
M
Inoue
Yumiko
Y
Nakagawa
Shin
S
Yabana
Takafumi
T
Urushibara
Takako
T
Kanai
Rie
R
Aihara
Masako
M
Yuuki
Naoya
N
Otsubo
Tempei
T
Oshima
Akihiko
A
Kudo
Koutaro
K
Inoue
Takeshi
T
Kitaichi
Yuji
Y
Shirakawa
Osamu
O
Isogawa
Koichi
K
Nagayama
Haruo
H
Kamijima
Kunitoshi
K
Nanko
Shinichiro
S
Kanba
Shigenobu
S
Higuchi
Teruhiko
T
Mikuni
Masahiko
M
D000328:Adult; D000367:Age Factors; D003346:Corticotropin-Releasing Hormone; D003865:Major Depressive Disorder / Q000503:physiopathology*; D003907:Dexamethasone; D005260:Female; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D011569:Psychiatric Status Rating Scales; D012727:Sex Characteristics
D003907:Dexamethasone; D003346:Corticotropin-Releasing Hormone