Evaluation of a salivary based combined dexamethasone/CRH test in patients with major depression

• Published in: Psychoneuroendocrinology 2002-04, Vol.27 (3), p.385-399
• Main Authors: Baghai, Thomas C, Schüle, Cornelius, Zwanzger, Peter, Minov, Christo, Holme, Christina, Padberg, Frank, Bidlingmaier, Martin, Strasburger, Christian J, Rupprecht, Rainer
• Format: Article
• Language: English
• Subjects: ACTH; Adult; Antidepressive Agents - therapeutic use; Biological and medical sciences; Bipolar Disorder - blood; Bipolar Disorder - diagnosis; Bipolar Disorder - drug therapy; Combined Dex/CRH test; Corticotropin-Releasing Hormone; Cortisol; Depressive Disorder, Major - blood; Depressive Disorder, Major - diagnosis; Depressive Disorder, Major - drug therapy; Dexamethasone; Female; Follow-Up Studies; Humans; Hydrocortisone - blood; Major depression; Male; Middle Aged; Saliva; Saliva - metabolism; Treatment Outcome
• ISSN: 0306-4530; 1873-3360
• DOI: 10.1016/S0306-4530(01)00060-9

The combined dexamethasone/corticotropin releasing hormone (Dex/CRH) test is one of the most reliable neuroendocrine function tests for investigation of hypothalamic–pituitary–adrenocortical (HPA) system dysregulation in depression. Persistent high HPA system activity reflected by an enhanced cortisol secretion during the Dex/CRH test after successful antidepressant treatment is correlated with an enhanced risk for relapse in remitted depressives. Thus, the Dex/CRH test might be a useful neuroendocrinological tool for treatment monitoring. However, the performance of the test requiring multiple blood samplings renders this test difficult for routine clinical use. Thus, a simplified test procedure using a saliva based test without the necessity of multiple blood samplings would be desirable. Therefore, we compared matched saliva and serum probes of Dex/CRH tests of 73 depressed patients who underwent a total of 157 tests. Both saliva and serum cortisol concentrations showed a significant stimulation pattern during the test and were highly correlated. This correlation was not influenced by either antidepressive treatment. In patients with high cortisol secretion patterns during the Dex/CRH test there was a decrease in HPA system activity after successful antidepressant treatment that was reflected by both the saliva and the serum Dex/CRH test. Thus, the saliva based combined Dex/CRH test appears to be a suitable tool for monitoring HPA system activity during the course of depressive illness. The easier performance of the saliva Dex/CRH test in comparison to the standard test procedure for both patients and hospital staff opens the door for routine clinical use of the Dex/CRH test for treatment monitoring and estimation of relapse risk.