title: The DEX/CRH neuroendocrine test and the prediction of depressive relapse in remitted depressed outpatients.
abstract: Hypothalamo-pituitary-adrenal (HPA) system dysfunction is the most characteristic biological alteration found in a majority of depressed patients. Accumulating evidence suggests that the combined dexamethasone (DEX)/corticotropin-releasing hormone (CRH) test is highly sensitive to detect HPA system abnormalities. The aim of this study was to evaluate whether the DEX/CRH test has a predictive value for the risk of depressive relapse in outpatients who are in clinical remission from a major depressive episode. Thirty-eight depressed outpatients (23 women, 15 men) in remission (MADRS score < or =8) underwent the DEX/CRH test and were followed up for 12 months regarding the occurrence of a new depressive episode. In parallel we recruited 24 controls (13 men and 11 women). The main result is a statistically significant difference concerning the delta and AUC numbers for cortisol plasmatic values between the group of patients who relapsed during the 1-year follow-up and control subjects, but not between the group of patients with prolonged remission and controls. These results suggest that in outpatients who are in clinical remission from a major depressive episode, high delta and AUC values in the DEX/CRH test compared to controls subjects can be associated with a higher risk of relapse.
authors.affiliation: Department of Psychiatry, Adult Psychiatric Service - Secteur-2, 16-18 Boulevard St-Georges, CH-1205 Geneva, Switzerland. jean-michel.aubry@hcuge.ch
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Aubry
authors.forename: Nicola
authors.initials: N
authors.lastname: Gervasoni
authors.forename: Christian
authors.initials: C
authors.lastname: Osiek
authors.forename: Guillaume
authors.initials: G
authors.lastname: Perret
authors.forename: Michel Florian
authors.initials: MF
authors.lastname: Rossier
authors.forename: Gilles
authors.initials: G
authors.lastname: Bertschy
authors.forename: Guido
authors.initials: G
authors.lastname: Bondolfi
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D019540:Area Under Curve; D016009:Chi-Square Distribution; D003346:Corticotropin-Releasing Hormone; D003863:Depression / Q000097:blood / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011237:Predictive Value of Tests; D012008:Recurrence; D013997:Time Factors
chemical_list: D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone