Appelhof Bente C, Huyser Jochanan, Verweij Mijke, Brouwer Jantien P, van Dyck Richard, Fliers Eric, Hoogendijk Witte J G, Tijssen Jan G P, Wiersinga Wilmar M, Schene Aart H
Department of Endocrinology and Metabolism, Academic Medical Center of the University of Amsterdam, The Netherlands.
Biol Psychiatry. 2006 Apr 15;59(8):696-701. doi: 10.1016/j.biopsych.2005.09.008. Epub 2005 Dec 20.
Knowledge of pathogenic mechanisms and predictors of relapse in major depressive disorder is still limited. Hypothalamic-pituitary-adrenocortical (HPA) axis dysregulation is thought to be related to the development and course of depression.
We investigated whether dexamethasone/corticotropin-releasing hormone (DEX/CRH) test parameters were related to the occurrence of relapse in 45 outpatients with clinically remitted major depression. The DEX/CRH test was administered before and after 8 weeks of antidepressant treatment.
Posttreatment maximal adrenocorticotropic hormone (ACTH) and maximal cortisol levels, as well as delta ACTH and delta cortisol levels, were significantly higher (all p < .05) among patients who relapsed (n = 22) compared with patients in whom no relapse occurred (n = 23). Higher posttreatment maximal cortisol response on the DEX/CRH test was associated with shorter "relapse-free survival" (p = .05).
In outpatients with clinically remitted major depression, higher posttreatment maximal cortisol levels on the DEX/CRH test were associated with relapse of major depression.
关于重度抑郁症的发病机制及复发预测因素的认识仍然有限。下丘脑 - 垂体 - 肾上腺皮质（HPA）轴功能失调被认为与抑郁症的发生和病程有关。
我们调查了45例临床症状缓解的重度抑郁症门诊患者的地塞米松/促肾上腺皮质激素释放激素（DEX/CRH）试验参数是否与复发的发生有关。在抗抑郁治疗8周前后进行DEX/CRH试验。
与未复发的患者（n = 23）相比，复发患者（n = 22）治疗后的最大促肾上腺皮质激素（ACTH）和最大皮质醇水平，以及ACTH变化量和皮质醇变化量均显著更高（所有p < 0.05）。DEX/CRH试验中治疗后最大皮质醇反应较高与较短的“无复发生存期”相关（p = 0.05）。
在临床症状缓解的重度抑郁症门诊患者中，DEX/CRH试验中治疗后最大皮质醇水平较高与重度抑郁症复发有关。
