Persistent cortisol non-suppression after clinical recovery predicts symptomatic relapse in unipolar depression

Abstract

We assessed the length and the quality of remission of 13 unipolar endogenous depressed patients, DST non-suppressors before treatment, in a 2-year prospective study. During this period, we recorded stressful life events. Persistent dexamethasone non-suppression, after treatment and complete clinical recovery, correlated highly with early clinical relapse. All six non-normalizers but only one normalizer were rehospitalized within the following 2 years for a major depressive relapse. Persistent DST non-suppression was unrelated to any impact of drug discontinuation, the occurrence of stressful life events or the length of illness-free intervals in the patient's prior course of illness. Persistent DST non-suppression appears to have significant prognostic value.

Electroencephalographic Sleep and Hypothalamic–Pituitary–Adrenal Changes from Episode to Recovery in Depressed Adolescents

“…Increased HPA activity occurs in approximately 40% of depressed patients, with normalization occurring during remission. Nonnormalization of the HPA activity might be associated with an early relapse of depressive episode (Targum 1983;Holsboer et al 1987;Charles et al 1989;Cosgriff et al 1990). Congruent with these reports, all of the participants in the current study continued to remain in remission for at least 3 months following participation in the sleep and neuroendocrine protocol in the remitted state.…”

Do Corticosteroids Damage the Brain?

“…Alterations in central neural rhythmic events thus play a part in suboptimal brain function, implying that changes in peripheral corticosteroid patterns may contribute to this malfunction. For example, persistence of either evening hypercortisolaemia or resistance to dexamethasone negative feedback in unipolar depression predicts recurrence or relapse (24, 25). The complex nature of the diurnal cycle of corticosteroids as well as their episodic responses to external events means that assessing corticosteroid function at a single time point gives a highly incomplete picture of their true activity.…”

The Combined Dexamethasone/CRH Test (DEX/CRH Test) and Prediction of Acute Treatment Response in Major Depression

“…In addition, in outpatients with clinically remitted major depression, higher cortisol levels in the DEX/CRH test are apparently associated with relapse of major depression [36], [37]. Interestingly, persisting nonsuppression in the single dexamethasone suppression test (DST) also indicates a higher risk for relapse within the following months [38]–[43]. It has further been postulated that antidepressants may exert their therapeutic effects at least partly through their actions on the HPA system and that all antidepressants developed so far may have a uniform dampening impact on HPA axis function irrespective of their type of action within monoaminergic systems [1], [2], [44]–[46].…”