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Hypothalamic-pituitary-adrenal axis function in patients with chronic depression

Lookup NU author(s): Dr Stuart Watson, Dr Peter Gallagher, Emeritus Professor Nicol Ferrier, Professor Allan Young

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Abstract

Background. Hypothalamic pituitary-adrenal (HPA) axis function in patients with chronic depression has previously been shown to be normal when measured using the dexamethasone suppression test (DST). We examined patients with chronic depression using the sensitive dexamethasone/corticotropin releasing hormone (dex/CRH) test and the dexamethasone suppression test (DST) to establish whether HPA axis abnormalities are present in this group. We also compared the sensitivity of the two tests and compared the results with previous studies in depression that have not specifically selected chronic patients. Method. Twenty-nine patients with the chronic subtype of major depressive disorder and 28 matched controls underwent examination of HPA axis function. Results. Neither the cortisol response to the DST or the dex/CRH test differed significantly between the patient and control groups. There was a trend in favour of more patients than controls having an abnormal response to the dex/CRH test (P = 0.052). Neither the patients with an abnormally enhanced response, nor the magnitude of response could be predicted by any illness or demographic variable. Conclusion. The HPA axis is not overtly abnormal in chronic depression. This contrasts with previous findings in acute depression and bipolar disorder and may suggest that the HPA axis abnormalities present in acute depression resolve, but are not accompanied by symptom resolution. Alternatively, a subgroup of depressives with less HPA dysfunction may progress to chronicity. This has implications for treatment and prognosis. The dex/CRH is a more sensitive test of HPA axis function than the DST in patients with chronic depression.


Publication metadata

Author(s): Watson S, Gallagher P, Del-Estal D, Hearn A, Ferrier IN, Young AH

Publication type: Article

Publication status: Published

Journal: Psychological Medicine

Year: 2002

Volume: 32

Issue: 6

Pages: 1021-1028

Print publication date: 01/08/2002

ISSN (print): 0033-2917

ISSN (electronic): 1469-8978

Publisher: Cambridge University Press

URL: http://dx.doi.org/10.1017/S0033291702005998

DOI: 10.1017/S0033291702005998

PubMed id: 12214783


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