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Differences in the response to the combined DEX-CRH test between PTSD patients with and without co-morbid depressive disorder.
Psychoneuroendocrinology. 2008 Apr; 33(3):313-20.P

Abstract

BACKGROUND

Neuroendocrine studies have shown profound alterations in HPA-axis regulation in posttraumatic stress disorder (PTSD). Based on baseline assessments and the response to dexamethasone, a hypothalamic overdrive with enhanced glucocorticoid feedback inhibition has been suggested. The dexamethasone-corticotrophin releasing hormone (DEX-CRH) test has shown to be a more sensitive test to assess HPA-axis dysregulation in major depression and therefore may provide a useful test tool to probe HPA-axis regulation in PTSD.

METHODS

To evaluate the effect of PTSD on HPA-axis regulation, we compared the response to a DEX-CRH test between male veterans with PTSD (n=26) and male veterans, who had been exposed to similar traumatic events during their deployment, without PTSD (n=23). Patients and controls were matched on age, year and region of deployment. Additionally, we compared the response of PTSD patients with (n=13) and without co-morbid major depressive disorder (MDD) (n=13).

RESULTS

No significant differences were observed in ACTH and cortisol response to the DEX-CRH test between patients and controls. PTSD patients with co-morbid MDD showed a significantly lower ACTH response compared to patients without co-morbid MDD. The response to the DEX-CRH test did not correlate with PTSD or depressive symptoms.

CONCLUSION

The DEX-CRH test did not reveal HPA-axis abnormalities in PTSD patients as compared to trauma controls. PTSD patients with a co-morbid MDD showed an attenuated ACTH response compared to PTSD patients without co-morbid MDD, suggesting the presence of subgroups with different HPA-axis regulation within the PTSD group. Altered sensitivity of the CRH receptors at the pituitary or differences in AVP secretion might explain these differences in response.

Authors+Show Affiliations

Department of Military Psychiatry, Central Military Hospital, Utrecht, The Netherlands. c.de.kloet@altrecht.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18215470

Citation

de Kloet, Carien, et al. "Differences in the Response to the Combined DEX-CRH Test Between PTSD Patients With and Without Co-morbid Depressive Disorder." Psychoneuroendocrinology, vol. 33, no. 3, 2008, pp. 313-20.
de Kloet C, Vermetten E, Lentjes E, et al. Differences in the response to the combined DEX-CRH test between PTSD patients with and without co-morbid depressive disorder. Psychoneuroendocrinology. 2008;33(3):313-20.
de Kloet, C., Vermetten, E., Lentjes, E., Geuze, E., van Pelt, J., Manuel, R., Heijnen, C., & Westenberg, H. (2008). Differences in the response to the combined DEX-CRH test between PTSD patients with and without co-morbid depressive disorder. Psychoneuroendocrinology, 33(3), 313-20. https://doi.org/10.1016/j.psyneuen.2007.11.016
de Kloet C, et al. Differences in the Response to the Combined DEX-CRH Test Between PTSD Patients With and Without Co-morbid Depressive Disorder. Psychoneuroendocrinology. 2008;33(3):313-20. PubMed PMID: 18215470.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Differences in the response to the combined DEX-CRH test between PTSD patients with and without co-morbid depressive disorder. AU - de Kloet,Carien, AU - Vermetten,Eric, AU - Lentjes,Eef, AU - Geuze,Elbert, AU - van Pelt,Johannes, AU - Manuel,Remy, AU - Heijnen,Cobi, AU - Westenberg,Herman, Y1 - 2008/01/22/ PY - 2007/04/01/received PY - 2007/11/22/revised PY - 2007/11/26/accepted PY - 2008/1/25/pubmed PY - 2008/5/14/medline PY - 2008/1/25/entrez SP - 313 EP - 20 JF - Psychoneuroendocrinology JO - Psychoneuroendocrinology VL - 33 IS - 3 N2 - BACKGROUND: Neuroendocrine studies have shown profound alterations in HPA-axis regulation in posttraumatic stress disorder (PTSD). Based on baseline assessments and the response to dexamethasone, a hypothalamic overdrive with enhanced glucocorticoid feedback inhibition has been suggested. The dexamethasone-corticotrophin releasing hormone (DEX-CRH) test has shown to be a more sensitive test to assess HPA-axis dysregulation in major depression and therefore may provide a useful test tool to probe HPA-axis regulation in PTSD. METHODS: To evaluate the effect of PTSD on HPA-axis regulation, we compared the response to a DEX-CRH test between male veterans with PTSD (n=26) and male veterans, who had been exposed to similar traumatic events during their deployment, without PTSD (n=23). Patients and controls were matched on age, year and region of deployment. Additionally, we compared the response of PTSD patients with (n=13) and without co-morbid major depressive disorder (MDD) (n=13). RESULTS: No significant differences were observed in ACTH and cortisol response to the DEX-CRH test between patients and controls. PTSD patients with co-morbid MDD showed a significantly lower ACTH response compared to patients without co-morbid MDD. The response to the DEX-CRH test did not correlate with PTSD or depressive symptoms. CONCLUSION: The DEX-CRH test did not reveal HPA-axis abnormalities in PTSD patients as compared to trauma controls. PTSD patients with a co-morbid MDD showed an attenuated ACTH response compared to PTSD patients without co-morbid MDD, suggesting the presence of subgroups with different HPA-axis regulation within the PTSD group. Altered sensitivity of the CRH receptors at the pituitary or differences in AVP secretion might explain these differences in response. SN - 0306-4530 UR - https://www.unboundmedicine.com/medline/citation/18215470/Differences_in_the_response_to_the_combined_DEX_CRH_test_between_PTSD_patients_with_and_without_co_morbid_depressive_disorder_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0306-4530(07)00262-4 DB - PRIME DP - Unbound Medicine ER -