Effects of mirtazapine on dehydroepiandrosterone-sulfate and cortisol plasma concentrations in depressed patients.
BACKGROUND
Among the neuroactive steroids, dehydroepiandrosterone sulfate (DHEA-S) is at least in part produced in the adrenal gland and is therefore under the control of the hypothalamic-pituitary-adrenocortical (HPA)-system. In the present study, the impact of mirtazapine on DHEA-S and cortisol (COR) levels was investigated in relation to clinical response in depressed patients.


METHODS
A total of 23 inpatients suffering from a major depressive episode (DSM-IV criteria) underwent 5-week treatment with mirtazapine (45 mg/day). Plasma samples were taken weekly at 0800 h and quantified for COR and DHEA-S levels.


RESULTS
Mirtazapine significantly reduced both COR and DHEA-S concentrations, but had no impact on the COR/DHEA-S ratio. The percentage decrease of DHEA-S, but not that of COR was significantly and positively correlated with the percentage reduction in the sum score of the Hamilton Depression Rating Scale at week 5, suggesting a relationship between DHEA-S reduction and clinical efficacy of mirtazapine. There was a significant positive correlation between the decline in COR and DHEA-S levels.


CONCLUSIONS
Apparently, the decrease in COR and DHEA-S concentrations conjointly reflects an attenuating impact of mirtazapine on HPA axis activity, thereby decreasing the adrenal secretion of COR and DHEA-S.
Schüle
Cornelius
C
Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Nussbaumstrasse 7, 80336 Munich, Germany. Cornelius.Schuele@med.uni-muenchen.de
Baghai
Thomas C
TC
Eser
Daniela
D
Schwarz
Markus
M
Bondy
Brigitta
B
Rupprecht
Rainer
R
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000929:Antidepressive Agents, Tricyclic / Q000097:blood* / Q000494:pharmacology / Q000627:therapeutic use; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood* / Q000737:chemistry; D003866:Depressive Disorder / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D008803:Mianserin / Q000031:analogs & derivatives* / Q000097:blood / Q000494:pharmacology / Q000627:therapeutic use; D008875:Middle Aged; D000078785:Mirtazapine; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D000929:Antidepressive Agents, Tricyclic; D008803:Mianserin; D019314:Dehydroepiandrosterone Sulfate; D000078785:Mirtazapine; D006854:Hydrocortisone