Glucocorticoids and Relapse of Major Depression (Dexamethasone/Corticotropin-Releasing Hormone Test in Relation to Relapse of Major Depression)

Background Knowledge of pathogenic mechanisms and predictors of relapse in major depressive disorder is still limited. Hypothalamic–pituitary–adrenocortical (HPA) axis dysregulation is thought to be related to the development and course of depression. Methods We investigated whether dexamethasone/corticotropin-releasing hormone (DEX/CRH) test parameters were related to the occurrence of relapse in 45 outpatients with clinically remitted major depression. The DEX/CRH test was administered before and after 8 weeks of antidepressant treatment. Results Posttreatment maximal adrenocorticotropic hormone (ACTH) and maximal cortisol levels, as well as delta ACTH and delta cortisol levels, were significantly higher (all p< .05) among patients who relapsed (n = 22) compared with patients in whom no relapse occurred (n = 23). Higher posttreatment maximal cortisol response on the DEX/CRH test was associated with shorter “relapse-free survival” (p = .05). Conclusions In outpatients with clinically remitted major depression, higher posttreatment maximal cortisol levels on the DEX/CRH test were associated with relapse of major depression.