Cortisol response in the combined dexamethasone/CRH test as predictor of relapse in patients with remitted depression. a prospective study.
ABSTRACT 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.
SourceAvailable from: Lars Schwabe[Show abstract] [Hide abstract]
ABSTRACT: Urbanization is a major challenge for the 21st century with a significant impact on health; mental health, in particular, can be negatively affected. The mechanisms linking urban living to psychopathology, however, remain unclear. We tested the hypothesis that urban upbringing may alter the activity of the hypothalamus-pituitary-adrenal (HPA) axis, one of the body's major stress response systems.
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ABSTRACT: Depression is a chronic, recurrent and long-term disorder characterized by high rates of impairment and several comorbidities. Early life stress (ELS) is associated with the increased risk fordeveloping depression in adulthood, influencesits clinical course and predicts a poorer treatment outcome. Stressful life events play an important role in the pathogenesis of depression, being well established as acute triggers of psychiatric illness. The vulnerability for developing depression is associated to changes in neurobiological systems related to stress regulation. The hypothalamic-pituitary-adrenal (HPA) axisrespondsto external and internal stimuli. Reported results indicate that stress in early phases of development can induce persistent changes in the responseof the HPA axis to stress in adulthood, leading to a raised susceptibility to depression. These abnormalities appear to be related to the HPA axis deregulation in depression, partially due to an imbalance between glucocorticoid receptors (GR) andmineralocorticoid receptors(MR). While most studies have consistently demonstrated GR function is impaired in major depression (reduced GR-mediated feedback in HPA axis), data about the MR rolein depression are still limited and controversial. Thus, in this review article we summarizethe main reported findings about the consequencesofELS in HPA axis functioning and in the responsivityof MR/GR receptors in depression.Current Pharmaceutical Design 01/2015; 21. DOI:10.2174/1381612821666150105125500 · 3.29 Impact Factor
Article: Cortisol as a marker of stress[Show abstract] [Hide abstract]
ABSTRACT: The review considers the roles cortisol (Crt), dehydroepiandrosterone (DHEA), and DHEA sulfate (DHEA-S) play in the stress response. Age-related, sex-related, and circadian fluctuations in normal conditions and in acute or chronic stress are described for Crt, DHEA, and DHEA-S. The main techniques used to estimate the Crt level in the blood, urine, and saliva are described, and approaches to the interpretation of the results discussed. Special attention is paid to Crt assays in anthropological and psychological studies.Human Physiology 03/2014; 40(2):224-236. DOI:10.1134/S0362119714020091