title: Combined dexamethasone suppression-corticotrophin-releasing hormone stimulation test in medication-free major depression and healthy volunteers.
abstract: BACKGROUND
  The hypothalamic-pituitary-adrenal (HPA) axis is dysfunctional in a subgroup of mood disorders.
  
  
  METHODS
  We compared cortisol and adrenocorticotropic hormone (ACTH) responses in major depression and healthy volunteers to the combined dexamethasone suppression-corticotrophin-releasing hormone stimulation (DEX-CRH) test. Unlike other published studies, the study patients were medication-free and the healthy volunteers did not have first-degree relatives with a mood or psychotic disorder. Demographics, DSM-IV diagnoses and other clinical parameters were evaluated in major depressive disorder (MDD) and healthy control groups. Participants received an oral dose of 1.5mg dexamethasone at 11 pm the day before CRH administration. On the following day, at 3 pm, 100 µg of ovine CRH was infused. Blood samples for determination of cortisol and ACTH were collected every 15 min from 3 pm to 4:15 pm. Cortisol and ACTH responses were calculated as areas under the curve.
  
  
  RESULTS
  Controlling for age, baseline (i.e., post-dexamethasone) ACTH levels were higher in depressed patients compared to controls (p=0.01). There was a trend for higher ACTH responses in depressed patients compared to the control group (p=0.08). In depressed patients, cortisol and ACTH responses correlated positively with age, duration of illness and number of hospitalizations.
  
  
  CONCLUSIONS
  Because of the cross-sectional study design we can only evaluate the nature of potential HPA axis disturbances that were present in patients when they are acutely depressed.
  
  
  CONCLUSIONS
  Feedback inhibition of ACTH secretion by cortisol is compromised in MDD, and this is independent of an age effect on the HPA axis function.
authors.affiliation: New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA; James J. Peters Veterans' Administration Medical Center and Icahn School of Medicine at Mount Sinai, 130 West Kingsbridge Road, Bronx, New York, NY, USA. Electronic address: Leo.Sher@mssm.edu.
authors.forename: Leo
authors.initials: L
authors.lastname: Sher
authors.forename: Maria A
authors.initials: MA
authors.lastname: Oquendo
authors.forename: Ainsley K
authors.initials: AK
authors.lastname: Burke
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Cooper
authors.forename: J John
authors.initials: JJ
authors.lastname: Mann
mesh_terms: D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000367:Age Factors; D000928:Antidepressive Agents / Q000008:administration & dosage; D016022:Case-Control Studies; D003346:Corticotropin-Releasing Hormone / Q000494:pharmacology*; D003865:Major Depressive Disorder / Q000097:blood / Q000503:physiopathology*; D003907:Dexamethasone / Q000494:pharmacology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000187:drug effects / Q000503:physiopathology*; D011569:Psychiatric Status Rating Scales; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone
keywords: Adrenocorticotropic hormone; Corticotrophin-releasing hormone; Cortisol; Depression; Dexamethasone; Hypothalamic–pituitary–adrenal axis