Dexamethasone suppression tests in antidepressant treatment of melancholia. The process of normalization and test-retest reproducibility

Greden, John F.; Gardner, Robert; King, Doug; Grunhaus, Leon; Carroll, Bernard J.; Kronfol, Ziad

doi:10.1097/00004714-198310000-00025

Cited by 51 publications

(59 citation statements)

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“…Our finding is in conformity with observations from earlier investigations [11,14,31]. Whether the normalized CORT abnormality is a marker of clinical improvement, i.e.…”

Section: Discussionsupporting

confidence: 93%

Decreased Plasma Prolactin Release in Euthymic Lithium-Treated Women with Bipolar Disorder

et al. 2003

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In order to evaluate the effect of treatment with citalopram (CIT) and lithium (Li) on hormone levels in women with bipolar disorder, morning plasma prolactin (PRL) and cortisol (CORT) were measured in 14 nonmedicated depressed patients, 13 depressed patients responding to CIT treatment, 17 euthymic patients on long-term Li treatment, and 11 healthy controls. Plasma PRL values in the Li group were significantly lower than those of the three other groups, suggesting a net inhibitory impact of augmentative effects of Li on dopaminergic activity and serotonergic neurotransmission in the central nervous system. Plasma CORT values in nonmedicated depressed patients were significantly higher than those of healthy controls, indicating hyperactivity of the hypothalamic-pituitary-adrenal system in depression, which appears to be a state-dependent phenomenon, and is normalized upon successful treatment with Li and CIT.

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“…Our finding is in conformity with observations from earlier investigations [11,14,31]. Whether the normalized CORT abnormality is a marker of clinical improvement, i.e.…”

Section: Discussionsupporting

confidence: 93%

Decreased Plasma Prolactin Release in Euthymic Lithium-Treated Women with Bipolar Disorder

et al. 2003

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“…Moreover, a disturbed HPA axis regulation seems also to be implicated in the precipitation of psychiatric disease, such as major depression, and patients with Cushing's disease often suffer from changes in mood and affect reminiscent to those observed in major depressive illness (73,74). Treatment of depressed patients with antidepressants has been shown to normalize HPA axis function before clinical improvement was noted (75)(76)(77). The correction ofCushing's disease is usually followed by an alleviation of the depressive symptoms (74).…”

Section: Discussionmentioning

confidence: 99%

Prenatal immune challenge alters the hypothalamic-pituitary-adrenocortical axis in adult rats.

Reul¹,

Stec²,

Wiegers³

et al. 1994

J. Clin. Invest.

133

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We investigated whether non-abortive maternal infections would compromise fetal brain development and alter hypothalamic-pituitary-adrenocortical (HPA) axis functioning when adult. To study putative teratogenic effects of a T cell-mediated immune response versus an endotoxic challenge, 10-d-pregnant rats received a single intraperitoneal injection of 5 X 10i human red blood cells (HRBC) or gram-negative bacterial endotoxin (Escherichia coli LPS: 30 ag/kg). The adult male progeny (3 mo old) of both experimental groups showed increased basal plasma corticosterone levels. In addition, after novelty stress the HRBC group, but not the LPS group, showed increased AC'H and corticosterone levels. Both groups showed substantial decreases in mineralocorticoid (MR) and glucocorticoid receptor (GR) levels in the hippocampus, a limbic brain structure critical for HPA axis regulation, whereas GR concentrations in the hypothalamus were unchanged and in anterior pituitary were slightly increased. HRBC and LPS indeed stimulated the maternal immune system as revealed by specific anti-HRBC antibody production and enhanced IL-1ft mRNA expression in splenocytes, respectively. This study demonstrates that a T cell-mediated immune response as well as an endotoxic challenge during pregnancy can induce anomalies in HPA axis function in adulthood. Clinically, it may be postulated that disturbed fetal brain development due to prenatal immune challenge increases the vulnerability to develop mental illness involving inadequate responses to stress. (J. Clin. Invest. 1994.

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“…In serial DST studies, conversion from nonsuppressor to suppressor status is temporally associated with clinical responses to antidepressants (eg Holsboer et al, 1982;Greden et al, 1983). In line with this, hormonal responses to the DEX/CRH test also restored after successful treatment with antidepressants (Holsboer-Trachsler et al, 1991;Heuser et al, 1996;Baghai et al, 2002;Hatzinger et al, 2002), suggesting that the DEX/CRH test is a useful statedependent marker.…”

Section: Introductionmentioning

confidence: 94%

Assessment of the Dexamethasone/CRH Test as a State-Dependent Marker for Hypothalamic-Pituitary-Adrenal (HPA) Axis Abnormalities in Major Depressive Episode: A Multicenter Study

Kunugi

Ida

Owashi

et al. 2005

Neuropsychopharmacol

188

108

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There is compelling evidence for the involvement of hypothalamic-pituitary-adrenal (HPA) axis abnormalities in depression. Growing evidence has suggested that the combined dexamethasone (DEX)/corticotropin-releasing hormone (CRH) test is highly sensitive to detect HPA axis abnormalities. We organized a multicenter study to assess the DEX/CRH test as a state-dependent marker for major depressive episode in the Japanese population. We conducted the DEX/CRH test in 61 inpatients with major depressive episode (Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV)) and 57 healthy subjects. In all, 35 patients were repeatedly assessed with the DEX/CRH test on admission and before discharge. The possible relationships between clinical variables and the DEX/ CRH test were also examined. Significantly enhanced pituitary-adrenocortical responses to the DEX/CRH test were observed in patients on admission compared with controls. Such abnormalities in patients were significantly reduced after treatment, particularly in those who underwent electroconvulsive therapy (ECT) in addition to pharmacotherapy. Age and female gender were associated with enhanced hormonal responses to the DEX/CRH test. Severity of depression correlated with DEX/CRH test results, although this was explained, at least in part, by a positive correlation between age and severity in our patients. Medication per se was unrelated to DEX/CRH test results. These results suggest that the DEX/CRH test is a sensitive state-dependent marker to monitor HPA axis abnormalities in major depressive episode during treatment. Restoration from HPA axis abnormalities occurred with clinical responses to treatment, particularly in depressed patients who underwent ECT.

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Dexamethasone suppression tests in antidepressant treatment of melancholia. The process of normalization and test-retest reproducibility

Abstract: \s=b\Pilot studies suggest that changes in response to the dexamethasone suppression test (DST)

Cited by 51 publications

References 0 publications

Decreased Plasma Prolactin Release in Euthymic Lithium-Treated Women with Bipolar Disorder

Decreased Plasma Prolactin Release in Euthymic Lithium-Treated Women with Bipolar Disorder

Prenatal immune challenge alters the hypothalamic-pituitary-adrenocortical axis in adult rats.

Assessment of the Dexamethasone/CRH Test as a State-Dependent Marker for Hypothalamic-Pituitary-Adrenal (HPA) Axis Abnormalities in Major Depressive Episode: A Multicenter Study

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