title: Lithium monotherapy increases ACTH and cortisol response in the DEX/CRH test in unipolar depressed subjects. A study with 30 treatment-naive patients.
abstract: BACKGROUND
  Distorted activity of the hypothalamic-pituitary-adrenocortical (HPA) system is one of the most robustly documented biological abnormalities in major depression. Lithium is central to the treatment of affective disorders, but little is known about its effects on the HPA system of depressed subjects.
  
  
  OBJECTIVE
  To assess the effects of lithium monotherapy on the HPA system of patients with major depression by means of the combined DEX/CRH test.
  
  
  METHODS
  Thirty drug-naive outpatients with major depression (single episode or unipolar recurrent; SCID I- and II-confirmed) were treated with lithium monotherapy for four weeks. The DEX/CRH test was conducted directly before intake of the first lithium tablet and four weeks thereafter. Weekly ratings with the HDRS(21) were used to determine response (≥50% symptom reduction) and remission (HDRS ≤7).
  
  
  RESULTS
  Lithium levels within the therapeutic range were achieved rapidly. Tolerability was good; no patient terminated the treatment prematurely. Response and remission rates were 50% and 33% respectively. Compared to the DEX/CRH test before the start of the treatment, a considerable and significant increase in all CRH-stimulated ACTH and cortisol parameters could be detected in the second DEX/CRH test. When analysed with particular regard to responders and non-responders, that significant increase was only present in the responders.
  
  
  CONCLUSIONS
  We were able to demonstrate that lithium leads to a significant activation of the HPA system. This is possibly connected to stimulation of hypothalamic arginine vasoporessin (AVP), to direct intracellular effects of lithium on pituitary cells and to an induction of gene expression.
  
  
  BACKGROUND
  drks-nue.uniklinik-freiburg.de DRKS00003185.
authors: Department of Psychiatry, Schlosspark-Clinic, Berlin, Germany. bschor@mailbox.tu-dresden.de
authors: Tom
authors: T
authors: Bschor
authors: Dirk
authors: D
authors: Ritter
authors: Patricia
authors: P
authors: Winkelmann
authors: Sebastian
authors: S
authors: Erbe
authors: Manfred
authors: M
authors: Uhr
authors: Marcus
authors: M
authors: Ising
authors: Ute
authors: U
authors: Lewitzka
mesh_terms: D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000097:blood*; D000328:Adult; D000368:Aged; D003346:Corticotropin-Releasing Hormone; D003710:Demography; D003865:Major Depressive Disorder / Q000097:blood* / Q000188:drug therapy*; D003907:Dexamethasone; D019937:Diagnostic Techniques and Procedures; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008094:Lithium / Q000097:blood / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D008094:Lithium; D006854:Hydrocortisone