title: Prednisolone suppression test in depression: prospective study of the role of HPA axis dysfunction in treatment resistance.
abstract: BACKGROUND
  People with severe depressive illness have raised levels of cortisol and reduced glucocorticoid receptor function.
  
  
  OBJECTIVE
  To obtain a physiological assessment of hypothalamic-pituitary-adrenal (HPA) axis feedback status in an in-patient sample with depression and to relate this to prospectively determined severe treatment resistance.
  
  
  METHODS
  The prednisolone suppression test was administered to 45 in-patients with depression assessed as resistant to two or more antidepressants and to 46 controls, prior to intensive multimodal in-patient treatment.
  
  
  RESULTS
  The patient group had higher cortisol levels than controls, although the percentage suppression of cortisol output after prednisolone in comparison with placebo did not differ. Non-response to in-patient treatment was predicted by a more dysfunctional HPA axis (higher cortisol levels post-prednisolone and lower percentage suppression).
  
  
  CONCLUSIONS
  In patients with severe depression, HPA axis activity is reset at a higher level, although feedback remains intact. However, prospectively determined severe treatment resistance is associated with an impaired feedback response to combined glucocorticoid and mineralocorticoid receptor activation by prednisolone.
authors.affiliation: Section of Neurobiology of Mood Disorders, PO 74, Institute of Psychiatry, 103 Denmark Hill, London SE5 8AF, UK.
authors.forename: Mario F
authors.initials: MF
authors.lastname: Juruena
authors.forename: Carmine M
authors.initials: CM
authors.lastname: Pariante
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Papadopoulos
authors.forename: Lucia
authors.initials: L
authors.lastname: Poon
authors.forename: Stafford
authors.initials: S
authors.lastname: Lightman
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Cleare