title: Mirtazapine does not influence tetrahydrodeoxycorticosterone levels in depressed patients.
abstract: BACKGROUND
  Among the neuroactive steroids, 3alpha,5alpha-tetrahydrodeoxycorticosterone (3alpha,5alpha-THDOC) is at least in part produced in the adrenal gland and is therefore under the control of the hypothalamic-pituitary-adrenocortical (HPA) system. The antidepressant mirtazapine has been shown to attenuate HPA axis activity and to increase the concentrations of 3alpha-reduced metabolites of progesterone in depressed patients. In the present study, the impact of mirtazapine on 3alpha,5alpha-THDOC levels was investigated in relation to clinical response in depressed patients.
  
  
  METHODS
  A total of 23 drug-free 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 08:00 h and were quantified for 3alpha,5alpha-THDOC levels.
  
  
  RESULTS
  3alpha,5alpha-THDOC levels were not correlated with demographic and clinical parameters such as age and severity of depression. Moreover, 5-week treatment with mirtazapine did not influence the 3alpha,5alpha-THDOC in the depressed patients, neither in responders nor in non-responders.
  
  
  CONCLUSIONS
  Putative increasing effects of mirtazapine on 3alpha-reduced neuroactive steroids such as 3alpha,5alpha-THDOC which may be mediated via an impact on the neurosteroidogenic enzyme 3alpha-hydroxysteroid dehydrogenase seem to be counterbalanced by the mirtazapine-induced inhibition of ACTH secretion which directly influences the 3alpha,5alpha-THDOC release of the adrenal cortex.
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany. Cornelius.Schuele@med.uni-muenchen.de
authors.forename: Cornelius
authors.initials: C
authors.lastname: Schüle
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Baghai
authors.forename: Flavia
authors.initials: F
authors.lastname: di Michele
authors.forename: Daniela
authors.initials: D
authors.lastname: Eser
authors.forename: Augusto
authors.initials: A
authors.lastname: Pasini
authors.forename: Elena
authors.initials: E
authors.lastname: Romeo
authors.forename: Rainer
authors.initials: R
authors.lastname: Rupprecht
mesh_terms: D000328:Adult; D000368:Aged; D000929:Antidepressive Agents, Tricyclic / Q000494:pharmacology / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D003900:Desoxycorticosterone / Q000031:analogs & derivatives* / Q000097:blood; D005260:Female; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects / Q000503:physiopathology; D008297:Male; D008803:Mianserin / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D008875:Middle Aged; D000078785:Mirtazapine; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000929:Antidepressive Agents, Tricyclic; D008803:Mianserin; D003900:Desoxycorticosterone; C009413:tetrahydrodeoxycorticosterone; D000078785:Mirtazapine