Schüle Cornelius, Baghai Thomas C, Eser Daniela, Zwanzger Peter, Jordan Martina, Buechs Renate, Rupprecht Rainer
Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University of Munich, Nussbaumstr 7, Munich, 80336, Germany.
Psychopharmacology (Berl). 2006 Jul;186(4):601-11. doi: 10.1007/s00213-006-0382-7. Epub 2006 Apr 22.
In healthy subjects, cortisol and ACTH secretion are acutely stimulated by reboxetine and inhibited by mirtazapine. However, it was not investigated so far whether reboxetine and mirtazapine may also differ in their impact on hypothalamic-pituitary-adrenocortical (HPA) axis activity in depressed patients and whether these effects are related to clinical outcome.
In the present study, we investigated the impact of 5-week treatment with reboxetine or mirtazapine on the combined dexamethasone suppression/corticotropin releasing hormone (DEX/CRH) test results in depressed patients.
Forty drug-free patients suffering from a major depressive episode (Diagnostic and Statistical Manual of Mental Disorders-IV criteria) were treated with either reboxetine (8 mg/day; n=20) or mirtazapine (45 mg/day; n=20) for 5 weeks. Before, after 1 and 5 weeks of therapy, the DEX/CRH test was performed and cortisol and ACTH concentrations were measured.
During reboxetine treatment, a gradual and significant reduction in HPA axis activity as measured by the DEX/CRH test was seen, which was most pronounced after 5 weeks of treatment. In contrast, mirtazapine significantly reduced the cortisol and ACTH concentrations during the DEX/CRH test within 1 week. However, after 5 weeks of mirtazapine treatment, the cortisol and ACTH responses to the DEX/CRH test partially increased again both in responders and nonresponders.
This is the first study demonstrating differential effects of various antidepressants on the time course of serial DEX/CRH test results in depressed patients.
在健康受试者中，瑞波西汀可急性刺激皮质醇和促肾上腺皮质激素（ACTH）分泌，而米氮平则起抑制作用。然而，到目前为止，尚未研究瑞波西汀和米氮平对抑郁症患者下丘脑 - 垂体 - 肾上腺皮质（HPA）轴活性的影响是否也存在差异，以及这些影响是否与临床结局相关。
在本研究中，我们调查了瑞波西汀或米氮平5周治疗对抑郁症患者联合地塞米松抑制/促肾上腺皮质激素释放激素（DEX/CRH）试验结果的影响。
40例未服用过药物的重度抑郁发作患者（符合《精神障碍诊断与统计手册》第四版标准），分别接受瑞波西汀（8毫克/天；n = 20）或米氮平（45毫克/天；n = 20）治疗5周。在治疗前、治疗1周和5周后，进行DEX/CRH试验，并测量皮质醇和ACTH浓度。
在瑞波西汀治疗期间，通过DEX/CRH试验测得的HPA轴活性逐渐且显著降低，在治疗5周后最为明显。相比之下，米氮平在1周内显著降低了DEX/CRH试验期间的皮质醇和ACTH浓度。然而，米氮平治疗5周后，无论是反应者还是无反应者，皮质醇和ACTH对DEX/CRH试验的反应均再次部分升高。
这是第一项证明不同抗抑郁药对抑郁症患者连续DEX/CRH试验结果的时间进程有不同影响的研究。
