Prediction of relapse in melancholic depressive patients in a 2-year follow-up study with corticotropin releasing factor test.
OBJECTIVE
To study the power of CRF stimulation test to predict relapse in a sample of melancholic depressive patients in depressed phase, followed-up over a two-year period from the moment they achieved complete remission of depressive symptoms.


METHODS
Fifty-one outpatients diagnosed with unipolar depressive disorder with melancholic features according to DSM-IV were assessed with the CRF test. The Structured Clinical Interview for DSM-IV (SCID-IV) was used for diagnosis. Monthly follow-up visits were held over a two-year period after remission; relapse was established using HDRS according to Frank's criteria [Frank E, Prien RF, Jarret RB, Keller MB, Kupfer DJ, Lavori PW, et al. Conceptualization and rationale for consensus definitions of terms in major depressive disorder: remission, recovery, relapse, and recurrence. Arch Gen Psychiatry 1991;48:851-5]. Forty-three patients completed the study. Non-controlled antidepressant treatment protocols were used. Predictive statistical analysis was performed through logistic regression.


RESULTS
The final predictive model included three variables: net area under cortisol curve (NAUCC), previous suicide attempt, and stress during follow-up. Sensitivity was of 89%, and specificity was of 92%. NAUCC has shown a predictive power of 80%, with an optimal cut-off point of 251.24 microg/ml/min.


CONCLUSIONS
Cortisol is the hormone of the HPA axis which shows the highest power to predict relapse. NAUCC is the most relevant variable. The complete predictive model is a complex combination of biological, clinical and psychoenvironmental variables (NAUCC, previous suicide attempts, and stress during follow-up). Further studies with better control of the psychoenvironmental variables are required to obtain more precise neuroendocrine findings.
Pintor
Luis
L
Psychiatry Department, Neurosciences Institute, Hospital Clínico de Barcelona, C/Roselló 140, 08036 Barcelona, Spain. lpintor@clinic.ub.es
Torres
Xavier
X
Navarro
Victor
V
Martinez de Osaba
M A Jesús
MA
Matrai
Silvia
S
Gastó
Cristobal
C
D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D016009:Chi-Square Distribution; D003346:Corticotropin-Releasing Hormone / Q000008:administration & dosage; D003866:Depressive Disorder / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D012372:ROC Curve; D011863:Radioimmunoassay / Q000379:methods; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors
D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone