CRF test in melancholic depressive patients with partial versus complete relapses: a 2-year follow-up study.
BACKGROUND
Patients with depressive disorders present abnormalities in the hypothalamic pituitary adrenal (HPA) axis. The effects of a partial relapse with regard to HPA axis has not been studied so far.


OBJECTIVE
To assess whether patients with partial relapse have a different neuroendocrine profile compared with those with complete relapse and with those without relapse over a 2-year follow-up.


METHODS
The adrenocorticotropin hormone (ACTH) and cortisol responses to corticotrophin releasing factor (CRF) stimulation was assessed in 62 outpatients diagnosed with unipolar depressive disorder with melancholic features according to DSM-IV. Twenty-three healthy controls were included in the study for comparison. Monthly follow-up visits were performed over a 2-year period after remission; partial and complete relapses were established using the Hamilton Depression Rating Scale (HDRS) and according to Frank's criteria. Fifty-four patients completed the study. A comparative statistical analysis was performed.


RESULTS
Stratifying the net area under cortisol curve (NAUCC) (µg/ml/min) at three levels-< 150, 150-350 and ≤ 350-significant differences appear between the three depressive groups of patients (non-relapsers, partial relapsers and complete relapsers). Particularly, there are more patients with a NAUCC ≤ 350 who show partial or complete relapses than patients with a NAUCC ≤ 350 who do not relapse (P ≤ 0.05).


CONCLUSIONS
Our results show an increasingly altered HPA axis in those depressive patients with complete or partial relapses compared with those who did not relapse or with healthy controls, but there are not differences in HPA axis between partial and complete relapsers.
Psychiatry Department, Neurosciences Institute, Hospital Clínico de Barcelona, C/Roselló 140, 08036 Barcelona, Spain. lpintor@clinic.ub.es
Luis
L
Pintor
Xavier
X
Torres
Eva
E
Bailles
Victor
V
Navarro
María Jesús Martínez
MJ
de Osaba
Anna
A
Belmonte
Cristobal
C
Gastó
D000324:Adrenocorticotropic Hormone / Q000032:analysis; D000328:Adult; D016022:Case-Control Studies; D003346:Corticotropin-Releasing Hormone; D003866:Depressive Disorder / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D012008:Recurrence
D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone