title: Impact on cortisol and antidepressant efficacy of quetiapine and escitalopram in depression.
abstract: BACKGROUND
  In this study, the impact of quetiapine fumarate extended release (QXR) and escitalopram (ESC) on HPA axis activity was investigated in depressed patients in relationship to antidepressant efficacy.
  
  
  METHODS
  In a randomized, open-label 5-week trial 60 inpatients suffering from major depression (DSM-IV criteria) were treated for 5 weeks with either QXR (300 mg/day) or ESC (10mg/day). The dexamethasone/CRH (DEX/CRH) test was performed before treatment, after 1, and after 5 weeks of treatment. Cortisol (COR) AUC values were used to assess HPA axis function. The Hamilton Depression Rating Scale was used weekly to estimate antidepressant efficacy.
  
  
  RESULTS
  QXR and ESC showed comparable antidepressant effects but strongly differed in their impact on HPA axis activity. In the QXR group, a marked inhibition of COR AUC levels was observed which was most pronounced after one week of treatment but showed a partial re-increase after 5 weeks of treatment. In contrast, ESC transiently stimulated COR AUC values (week 1) whereas COR AUC levels at week 0 and week 5 were comparable. COR improvement at week 1 (defined as COR peak value reduction between DEX/CRH test 1 and 2) was significantly associated with better clinical outcome.
  
  
  CONCLUSIONS
  Apparently, different effects on HPA axis activity reflect distinct pharmacoendocrinological properties of psychotropic drugs.
authors.affiliation: Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany. Electronic address: nina.sarubin@med.uni-muenchen.de.
authors.forename: Nina
authors.initials: N
authors.lastname: Sarubin
authors.affiliation: Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany; Max-Planck-Institute of Psychiatry, Munich, Germany.
authors.forename: Caroline
authors.initials: C
authors.lastname: Nothdurfter
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schmotz
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.
authors.forename: Anna-Maria
authors.initials: AM
authors.lastname: Wimmer
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Trummer
authors.affiliation: Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Lieb
authors.affiliation: Max-Planck-Institute of Psychiatry, Munich, Germany.
authors.forename: Manfred
authors.initials: M
authors.lastname: Uhr
authors.affiliation: Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Baghai
authors.affiliation: Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Wetter
authors.affiliation: Department of Psychology/Statistics and Evaluation, Ludwig-Maximilian-University, Munich, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Bühner
authors.affiliation: Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany; Max-Planck-Institute of Psychiatry, Munich, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Rupprecht
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.
authors.forename: Cornelius
authors.initials: C
authors.lastname: Schüle
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D015283:Citalopram / Q000494:pharmacology / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D003987:Dibenzothiazepines / Q000494:pharmacology / Q000627:therapeutic use*; 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; D000069348:Quetiapine Fumarate; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D003987:Dibenzothiazepines; D015283:Citalopram; D000069348:Quetiapine Fumarate; D006854:Hydrocortisone
keywords: Escitalopram; HPA system; Major depression; Quetiapine