Elsevier

Biological Psychiatry

Volume 59, Issue 8, 15 April 2006, Pages 696-701
Biological Psychiatry

Original article
Glucocorticoids and Relapse of Major Depression (Dexamethasone/Corticotropin-Releasing Hormone Test in Relation to Relapse of Major Depression)

https://doi.org/10.1016/j.biopsych.2005.09.008Get rights and content

Background

Knowledge of pathogenic mechanisms and predictors of relapse in major depressive disorder is still limited. Hypothalamic–pituitary–adrenocortical (HPA) axis dysregulation is thought to be related to the development and course of depression.

Methods

We investigated whether dexamethasone/corticotropin-releasing hormone (DEX/CRH) test parameters were related to the occurrence of relapse in 45 outpatients with clinically remitted major depression. The DEX/CRH test was administered before and after 8 weeks of antidepressant treatment.

Results

Posttreatment maximal adrenocorticotropic hormone (ACTH) and maximal cortisol levels, as well as delta ACTH and delta cortisol levels, were significantly higher (all p < .05) among patients who relapsed (n = 22) compared with patients in whom no relapse occurred (n = 23). Higher posttreatment maximal cortisol response on the DEX/CRH test was associated with shorter “relapse-free survival” (p = .05).

Conclusions

In outpatients with clinically remitted major depression, higher posttreatment maximal cortisol levels on the DEX/CRH test were associated with relapse of major depression.

Section snippets

Methods and Materials

This study was carried out between February and May 2003 at the Academic Medical Center in Amsterdam. The study protocol was approved by the institutional ethics review committee, and all participants gave written informed consent.

Results

Of 47 unipolar depressed patients who had responded favorably to 8 weeks of outpatient treatment, 45 were available for follow-up. Of these 45 remitted patients, 23 (51%) had no relapse during the follow-up period, whereas 22 (49%) relapsed. Thirteen of these patients relapsed within the first 6 months after treatment. There were no differences between the relapsed and nonrelapsed groups with respect to the duration of follow-up, gender, age, T3 addition during treatment, or HRSD score after

Discussion

In this study we have investigated the relationship between posttreatment DEX/CRH test parameters and the occurrence of relapse in a population of outpatients with clinically remitted major depression after a mean follow-up of 22 months. Previously, only two small studies in a population of inpatients with a 6-month follow-up reported that higher HPA axis activity on the posttreatment DEX/CRH test predicted relapse (Zobel et al 1999, Zobel et al 2001).

First of all, the results of our study

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