Prediction of Medium-Term Outcome by Cortisol Response to the Combined Dexamethasone-CRH Test in Patients With Remitted Depression

OBJECTIVE: Current hypotheses hold that mechanisms underlying abnormal hypothalamic-pituitary-adrenocortical (HPA) function are causal factors in the precipitation of depression. If this is the case, then normalization of initially disturbed HPA regulation should indicate a good prognosis and persis...

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Bibliographic Details
Published in:The American journal of psychiatry 1999-06, Vol.156 (6), p.949-951
Main Authors: Zobel, Astrid W., Yassouridis, Alexander, Frieboes, Ralf-Michael, Holsboer, Florian
Format: Article
Language:English
Subjects:
Adult
Aged
Biological and medical sciences
Corticotropin-Releasing Hormone
Depressive Disorder - blood
Depressive Disorder - diagnosis
Dexamethasone
Female
Humans
Hydrocortisone - blood
Male
Medical sciences
Middle Aged
Neuropharmacology
Pharmacology. Drug treatments
Prognosis
Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease)
Psychology. Psychoanalysis. Psychiatry
Psychopharmacology
Recurrence
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Summary:OBJECTIVE: Current hypotheses hold that mechanisms underlying abnormal hypothalamic-pituitary-adrenocortical (HPA) function are causal factors in the precipitation of depression. If this is the case, then normalization of initially disturbed HPA regulation should indicate a good prognosis and persistent HPA dysregulation should be associated with a greater likelihood of relapse or chronicity. METHOD: The combined dexamethasone corticotropin-releasing hormone test was administered twice to inpatients with major depression (N=40), once after initiation of treatment and once after remission, shortly before discharge. RESULTS: Patients with a high cortisol response on both occasions or with a substantially increased cortisol response at discharge were at much higher risk for relapse within the next 6 months than those with low cortisol responses. CONCLUSIONS: An easy-to-administer neuroendocrine test allows the prediction of medium-term outcome in patients with remitted depression.
ISSN:0002-953X
1535-7228
DOI:10.1176/ajp.156.6.949