Early response to venlafaxine antidepressant correlates with lower ACTH levels prior to pharmacological treatment

被引:12
作者
Araya, A. V.
Rojas, P.
Fritsch, R.
Rojas, R.
Herrera, L.
Rojas, G.
Gatica, H.
Silva, H.
Fiedler, J. L.
机构
[1] Univ Chile, Dept Biochem & Mol Biol, Fac Chem & Pharmaceut Sci, Lab Neurobiochem,Sect Mol Neuroplast, Santiago 1, Chile
[2] Univ Chile, Clin Hosp, Santiago, Chile
[3] Univ Chile, ICBM, Fac Med, Santiago, Chile
关键词
depression; cortisol; ACTH; venlafaxine; ddAVP; AVP; CYP2D6*4;
D O I
10.1007/s12020-006-0007-2
中图分类号
R5 [内科学];
学科分类号
1002 [临床医学]; 100201 [内科学];
摘要
A link between stressful life events and development or exacerbation of depression has been established via a large body of evidence. An alteration in the regulation of the hypothalamic-pituitary-adrenal (HPA) axis in depression has also been associated with an increase in cortisol secretion. As arginine-vasopressin (AVP) plays an important role in the activation of HPA axis during stress, the present study investigated ACTH and cortisol secretory response induced by an AVP-related peptide desmopressin (ddAVP) in patients with major depression. Prior to antidepressant treatment, endocrinological parameters were evaluated and correlated with the clinical response to venlafaxine treatment, which offers a dual antidepressant action. Depressive patients with no other psychiatric pathology were evaluated with 17-item Hamilton Depression Scale (HAM-D) in order to follow-up the response to venlafaxine. After 1 wk of treatment, 60% of patients reduced their initial HAM-D score to at least 25%; this group was classified as early responders. The other group (40%) started to reduce significantly their HAM-D score after 3 wk of treatment and was classified as late responders. After 6 wk of treatment both groups have reduced HAM-D score to at least 25% of the baseline score. Prior to the pharmacological treatment, both early and late responders showed salivary cortisol rhythm and urinary free cortisol (UFC) in 24-h similar to healthy subjects. However, we did observe differences in basal ACTH secretion, showing that the late responder group had higher basal ACTH than both early responders and controls. The ddAVP challenge promoted a robust secretion of ACTH only in late responders, suggesting a different sensitivity of pituitary vasopressin receptor. The differences in clinical response to venlafaxine among depressive patients seem to be related to endocrinological parameters.
引用
收藏
页码:289 / 297
页数:9
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