The combined dexamethasone-CRH test before and after repetitive transcranial magnetic stimulation (rTMS) in major depression

• Published in: Psychoneuroendocrinology 2003-04, Vol.28 (3), p.376-385
• Main Authors: Zwanzger, P., Baghai, T.C., Padberg, F., Ella, R., Minov, C., Mikhaiel, P., Schüle, C., Thoma, H., Rupprecht, R.
• Format: Article
• Language: English
• Subjects: ACTH; Adult; Adult and adolescent clinical studies; Aged; Behavioral psychophysiology; Biological and medical sciences; Corticotropin-Releasing Hormone - metabolism; Cortisol; Depression; Depressive Disorder, Major - diagnosis; Depressive Disorder, Major - physiopathology; Depressive Disorder, Major - therapy; DEX/CRH test; Dexamethasone - metabolism; Electric Stimulation Therapy - methods; Electromagnetic Fields; Female; Fundamental and applied biological sciences. Psychology; Hormones and behavior; HPA-axis; Humans; Hypothalamo-Hypophyseal System - physiopathology; Major depression; Male; Medical sciences; Middle Aged; Mood disorders; Pituitary-Adrenal System - physiopathology; Prefrontal Cortex; Psychology. Psychoanalysis. Psychiatry; Psychology. Psychophysiology; Psychopathology. Psychiatry; Remission Induction; RTMS
• ISSN: 0306-4530; 1873-3360
• DOI: 10.1016/S0306-4530(02)00029-X

Background: Hypothalamic-pituitary-adrenocortical (HPA) dysregulation assessed by the combined dexamethasone corticotropin releasing hormone test (DEX/CRH test) has been demonstrated to normalize after successful antidepressant pharmacotherapy. Here, we investigated whether repetitive transcranial magnetic stimulation (rTMS) also leads to a normalization of HPA system activity in depressed patients. Methods: Thirty-seven medication free patients suffering from a major depressive episode (DSM-IV) underwent a DEX/CRH test before and after 13 daily sessions of left prefrontal rTMS in an open trial. Results: There was an overshoot of CRH-induced cortisol release that was not affected by rTMS treatment. Postdexamethasone cortisol levels prior to CRH challenge decreased in responders after rTMS treatment, whereas no change of CRH-induced adrenocorticotropic hormone (ACTH) and cortisol release in responders or nonresponders was observed. Conclusions: The persisting HPA system hyperactivity after rTMS suggests a high risk for relapse and therefore argues for an immediate maintenance therapy in patients responding to this treatment.