Heim Christine, Mletzko Tanja, Purselle David, Musselman Dominique L, Nemeroff Charles B
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Biol Psychiatry. 2008 Feb 15;63(4):398-405. doi: 10.1016/j.biopsych.2007.07.002. Epub 2007 Sep 7.
The dexamethasone/corticotropin-releasing factor (CRF) test is considered to be the most sensitive measure of hypothalamic-pituitary-adrenal (HPA) axis hyperactivity and has been demonstrated to be altered in patients with major depression (MDD). Although childhood trauma is a demonstrated risk factor for MDD and patients with a history of childhood abuse and MDD demonstrate HPA axis hyperactivity, the dexamethasone/CRF test remains unstudied in this population. We determined the impact of childhood trauma on dexamethasone/CRF test results in patients with MDD.
Forty-nine healthy men, ages 18-60 years, without mania or psychosis, active substance abuse, or eating disorder and medication-free were recruited into four study groups, including: 1) normal subjects with no childhood abuse history or psychiatric disorder (n = 14); 2) men with childhood abuse histories without current MDD (n = 14); 3) men with childhood abuse histories with current MDD (n = 15); and 4) men with current MDD and no childhood abuse history (n = 6). Plasma adrenocorticotropin (ACTH) and cortisol concentrations were measured in response to dexamethasone/CRF administration.
Men with childhood trauma histories exhibited increases in ACTH and cortisol responses to dexamethasone/CRF compared with non-abused men. In particular, abused men with current MDD showed increased responsiveness compared with control subjects and depressed men without childhood abuse experience. Increased response was associated with the severity, duration, and earlier onset of the abuse. The effects were not explained by concurrent posttraumatic stress disorder.
Childhood trauma increases HPA axis activity as measured with the dexamethasone/CRF test in adult men with MDD, potentially reflecting environmental risk for developing depression.
地塞米松/促肾上腺皮质激素释放因子（CRF）试验被认为是下丘脑-垂体-肾上腺（HPA）轴功能亢进最敏感的检测方法，且已证实在重度抑郁症（MDD）患者中该试验结果会发生改变。虽然童年创伤是MDD的一个已证实的危险因素，且有童年虐待史的MDD患者表现出HPA轴功能亢进，但地塞米松/CRF试验在这一人群中仍未得到研究。我们确定了童年创伤对MDD患者地塞米松/CRF试验结果的影响。
招募了49名年龄在18 - 60岁之间、无躁狂或精神病、无药物滥用或饮食失调且未服用药物的健康男性，分为四个研究组，包括：1）无童年虐待史或精神疾病的正常受试者（n = 14）；2）有童年虐待史但目前无MDD的男性（n = 14）；3）有童年虐待史且目前患有MDD的男性（n = 15）；4）目前患有MDD但无童年虐待史的男性（n = 6）。在给予地塞米松/CRF后测量血浆促肾上腺皮质激素（ACTH）和皮质醇浓度。
与未受虐待的男性相比，有童年创伤史的男性对地塞米松/CRF的ACTH和皮质醇反应增加。特别是，目前患有MDD的受虐待男性与对照组以及无童年虐待经历的抑郁症男性相比，反应性增加。反应增加与虐待的严重程度、持续时间和更早发作有关。这些影响不能用并发的创伤后应激障碍来解释。
在患有MDD的成年男性中，童年创伤会增加用地塞米松/CRF试验测量的HPA轴活性，这可能反映了患抑郁症的环境风险。
