Prednisolone suppression test in depression: prospective study of the role of HPA axis dysfunction in treatment resistance

被引:71
作者
Juruena, Mario F. [2 ,3 ]
Pariante, Carmine M.
Papadopoulos, Andrew S. [3 ]
Poon, Lucia [3 ]
Lightman, Stafford [4 ]
Cleare, Anthony J. [1 ,3 ]
机构
[1] Inst Psychiat, Sect Neurobiol Mood Disorders, London SE5 8AF, England
[2] Inst Psychiat, Sect Neurobiol Mood Disorders & Stress, Psychiat & Immunol Lab, SPI Lab, London SE5 8AF, England
[3] Bethlem Royal & Maudsley Hosp, Natl Affect Disorders Unit, Beckenham BR3 3BX, Kent, England
[4] Univ Bristol, Henry Wellcome Labs Integrat Neurosci & Endocrino, Bristol BS8 1TH, Avon, England
关键词
MAJOR DEPRESSION; DEXAMETHASONE/CRH TEST; CHILDHOOD EXPERIENCE; STRESS; SCALE; INVENTORY; RESPONSES; SUICIDE; ANXIETY; PHARMACOTHERAPY;
D O I
10.1192/bjp.bp.108.050278
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
Background People with severe depressive illness have raised levels of cortisol and reduced glucocorticoid receptor function. Aims To obtain a physiological assessment of hypothalamic-pituitary-adrenal (HPA) axis feedback status in an in-patient sample with depression and to relate this to prospectively determined severe treatment resistance. Method The prednisolone suppression test was administered to 45 in-patients with depression assessed as resistant to two or more antidepressants and to 46 controls, prior to intensive multimodal in-patient treatment. Results The patient group had higher cortisol levels than controls, although the percentage suppression of cortisol output after prednisolone in comparison with placebo did not differ. Nonresponse to in-patient treatment was predicted by a more dysfunctional HPA axis (higher cortisol levels post-prednisolone and lower percentage suppression). Conclusions In patients with severe depression, HPA axis activity is reset at a higher level, although feedback remains intact. However, prospectively determined severe treatment resistance is associated with an impaired feedback response to combined glucocorticoid and mineralocorticoid receptor activation by prednisolone.
引用
收藏
页码:342 / 349
页数:8
相关论文
共 48 条
[1]   Altered glucocorticoid immunoregulation in treatment resistant depression [J].
Bauer, ME ;
Papadopoulos, A ;
Poon, L ;
Perks, P ;
Lightman, SL ;
Checkley, S ;
Shanks, N .
PSYCHONEUROENDOCRINOLOGY, 2003, 28 (01) :49-65
[2]   Dexamethasone-induced effects on lymphocyte distribution and expression of adhesion molecules in treatment-resistant depression [J].
Bauer, ME ;
Papadopoulos, A ;
Poon, L ;
Perks, P ;
Lightman, SL ;
Checkley, S ;
Shanks, N .
PSYCHIATRY RESEARCH, 2002, 113 (1-2) :1-15
[3]  
BECK AT, 1988, J CLIN PSYCHOL, V44, P499, DOI 10.1002/1097-4679(198807)44:4<499::AID-JCLP2270440404>3.0.CO
[4]  
2-6
[5]   AN INVENTORY FOR MEASURING CLINICAL ANXIETY - PSYCHOMETRIC PROPERTIES [J].
BECK, AT ;
BROWN, G ;
EPSTEIN, N ;
STEER, RA .
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY, 1988, 56 (06) :893-897
[6]  
BECK AT, 1990, AM J PSYCHIAT, V147, P190
[7]   Comparison of Beck Depression Inventories-IA and -II in psychiatric outpatients [J].
Beck, AT ;
Steer, RA ;
Ball, R ;
Ranieri, WF .
JOURNAL OF PERSONALITY ASSESSMENT, 1996, 67 (03) :588-597
[8]   MEASUREMENT OF PESSIMISM - HOPELESSNESS SCALE [J].
BECK, AT ;
WEISSMAN, A ;
LESTER, D ;
TREXLER, L .
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY, 1974, 42 (06) :861-865
[9]   The childhood experience of care and abuse questionnaire (CECA.Q): Validation in a community series [J].
Bifulco, A ;
Bernazzani, O ;
Moran, RM ;
Jacobs, C .
BRITISH JOURNAL OF CLINICAL PSYCHOLOGY, 2005, 44 :563-581
[10]   CHILDHOOD EXPERIENCE OF CARE AND ABUSE (CECA) - A RETROSPECTIVE INTERVIEW MEASURE [J].
BIFULCO, A ;
BROWN, GW ;
HARRIS, TO .
JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, 1994, 35 (08) :1419-1435