Cortisol response in the combined dexamethasone/CRH test as predictor of relapse in patients with remitted depression: a prospective study

• Published in: Journal of psychiatric research 2001-03, Vol.35 (2), p.83-94
• Main Authors: Zobel, Astrid W., Nickel, Thomas, Sonntag, Annette, Uhr, Manfred, Holsboer, Florian, Ising, Marcus
• Format: Article
• Language: English
• Subjects: Adrenocorticotropic Hormone - blood; Adult; Adult and adolescent clinical studies; Antidepressive Agents - adverse effects; Antidepressive Agents - therapeutic use; Biological and medical sciences; Bipolar Disorder - blood; Bipolar Disorder - diagnosis; Bipolar Disorder - drug therapy; Corticotropin-Releasing Hormone; Cortisol response; Depression; Depressive Disorder, Major - blood; Depressive Disorder, Major - diagnosis; Depressive Disorder, Major - drug therapy; DEX/CRH Test; Dexamethasone; Female; Follow-Up Studies; Humans; Hydrocortisone - blood; Male; Medical sciences; Middle Aged; Mood disorders; Patient Discharge; Prediction; Predictive Value of Tests; Prospective Studies; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Recurrence; Relapse; Risk Factors; Treatment Outcome
• ISSN: 0022-3956; 1879-1379
• DOI: 10.1016/S0022-3956(01)00013-9

The development and course of depression is causally linked to impairment of central regulation of the hypothalamic-pituitary-adrenocortical (HPA) system. Previous research documented that the combined dexamethasone/corticotropin-releasing hormone (DEX/CRH) test identifies HPA dysfunction with high sensitivity. We evaluated the predictive validity for medium-term outcome of the cortisol response in the combined DEX/CRH test in 74 remitted patients previously suffering from major depressive disorder. Of the 74 patients, 61 remained in stable remission and 13 relapsed during the first 6 months after discharge from the hospital. Although the cortisol and ACTH responses in the DEX/CRH test did not differ between the two groups of patients on admission, the responses differed significantly just before discharge ( P< 0.05). We defined two dichotomous variables as prediction rules indicating (1) the change between admission and discharge in the cortisol response to the DEX/CRH test, and (2) the effect of the CRH infusion on cortisol as compared to the baseline level in the DEX/CRH test prior to discharge only. An elevated cortisol response in the DEX/CRH test was correlated with a four- to six-fold higher risk for relapse than in individuals with a normal cortisol response. The two proposed rules for predicting relapse within the first 6 months after discharge could be optimized by including age and gender. Hence, an exaggerated cortisol response in the combined DEX/CRH test predicts the recurrence of depressive psychopathology. The test performance can be further optimized if gender and age are taken into account.