Glucocorticoids and relapse of major depression (dexamethasone/corticotropin-releasing hormone test in relation to relapse of major depression).
BACKGROUND
Knowledge of pathogenic mechanisms and predictors of relapse in major depressive disorder is still limited. Hypothalamic-pituitary-adrenocortical (HPA) axis dysregulation is thought to be related to the development and course of depression.


METHODS
We investigated whether dexamethasone/corticotropin-releasing hormone (DEX/CRH) test parameters were related to the occurrence of relapse in 45 outpatients with clinically remitted major depression. The DEX/CRH test was administered before and after 8 weeks of antidepressant treatment.


RESULTS
Posttreatment maximal adrenocorticotropic hormone (ACTH) and maximal cortisol levels, as well as delta ACTH and delta cortisol levels, were significantly higher (all p < .05) among patients who relapsed (n = 22) compared with patients in whom no relapse occurred (n = 23). Higher posttreatment maximal cortisol response on the DEX/CRH test was associated with shorter "relapse-free survival" (p = .05).


CONCLUSIONS
In outpatients with clinically remitted major depression, higher posttreatment maximal cortisol levels on the DEX/CRH test were associated with relapse of major depression.
Appelhof
Bente C
BC
Department of Endocrinology and Metabolism, Academic Medical Center of the University of Amsterdam, The Netherlands. b.c.appelhof@amc.iva.nl
Huyser
Jochanan
J
Verweij
Mijke
M
Brouwer
Jantien P
JP
van Dyck
Richard
R
Fliers
Eric
E
Hoogendijk
Witte J G
WJ
Tijssen
Jan G P
JG
Wiersinga
Wilmar M
WM
Schene
Aart H
AH
D000293:Adolescent; D000328:Adult; D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use; D003346:Corticotropin-Releasing Hormone; D003865:Major Depressive Disorder / Q000378:metabolism*; D003907:Dexamethasone; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000378:metabolism*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D017374:Paroxetine / Q000627:therapeutic use; D010912:Pituitary-Adrenal Function Tests / Q000379:methods; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D012008:Recurrence; D012044:Regression Analysis; D013997:Time Factors
D018687:Antidepressive Agents, Second-Generation; D005938:Glucocorticoids; D017374:Paroxetine; D003907:Dexamethasone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone