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Combined dexamethasone/CRF test in remitted outpatients with recurrent major depressive disorder
Filip Van Den Eede1, Bart Van den Bossche, Wouter Hulstijn
1Collaborative Antwerp Psychiatric Research Institute, Universiteitsplein 1 B-2610 Antwerpen, University of Antwerp, Belgium.
Background:
Hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis is a prominent neurobiological finding during a major depressive episode, reflecting a state dependent factor. An issue under investigation is whether the dysfunction of the HPA axis has also a role to play as a state-independent or trait factor for major depressive disorder (MDD). In relation to this, it is important to examine HPA axis function in patients who are clinically remitted from depression.
Methods:
Twenty-three remitted outpatients with recurrent MDD and 23 age- and gender-matched control individuals without a history of MDD participated in the sensitive combined dexamethasone/corticotropin-releasing factor (DEX/CRF) test.
Results:
Free salivary cortisol responses were not significantly different between the two groups, although three patients (13%) displayed extremely elevated cortisol responses after CRF.
Limitations:
Limited sample size. All but one patient were under treatment with an antidepressant.
Conclusions:
This study shows no evidence for a disturbed DEX/CRF test as a state-independent factor in recurrent MDD on a group level. However, MDD is a complex and heterogenic disorder. Probably, there is a subgroup of patients who show a disturbed DEX/CRF test due to an inherited and/or acquired predisposition or as a biological scar after previous depressive episodes.
