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HPA-axis regulation at in-patient admission is associated with antidepressant therapy outcome in male but not in female depressed patients.
Psychoneuroendocrinology 2009; 34(1):99-109P

Abstract

A concatenation of data implicates a hyperactivity of the hypothalamus pituitary adrenal (HPA)-axis in the pathogenesis of depression and its normalization as a necessary predecessor of clinical response to antidepressant drugs. In addition, regulation of the HPA-axis has been shown to be dependent on sex hormones. We therefore investigated gender differences in HPA-axis regulation in depression and its normalization during remission of clinical symptoms. We used the combined dexamethasone suppression/CRH stimulation (Dex-CRH) test to evaluate the degree of HPA-axis dysregulation in 194 in-patients with unipolar depression from the Munich Antidepressant Response Signature (MARS) study at both admission and discharge. The Hamilton Depression (HAM-D) Rating Scale was used to monitor clinical response to antidepressant treatment. For both genders, we observed a normalization of HPA-axis dysregulation in remitters but not in non-remitters, both after 5 weeks of treatment and at discharge. The pattern of HPA-axis normalization with remission of depressive symptoms, however, showed gender-specific differences. In male patients, remission after 5 weeks of in-patient treatment was associated with a significantly higher cortisol response in the Dex-CRH test at admission. In female patients, 5-week remitters and non-remitters had a comparable cortisol response at admission. Cortisol response at admission was not correlated with gonadal steroid levels at this time point and the results were similar for pre-menopausal women vs. post-menopausal women. Gender-associated biological characteristics, likely independent of circulating gonadal steroids, thus seem to influence HPA-axis regulation in depression. In male patients, a single measure of HPA-axis dysregulation at admission may serve as a predictor of response to antidepressant treatment in addition to the previously reported repeated measure of the Dex-CRH test.

Authors+Show Affiliations

Max-Planck Institute of Psychiatry, Kraepelinstrasse 2-10, D80804 Munich, Germany. binder@mpipsykl.mpg.deNo affiliation info availableNo 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

18829172

Citation

Binder, E B., et al. "HPA-axis Regulation at In-patient Admission Is Associated With Antidepressant Therapy Outcome in Male but Not in Female Depressed Patients." Psychoneuroendocrinology, vol. 34, no. 1, 2009, pp. 99-109.
Binder EB, Künzel HE, Nickel T, et al. HPA-axis regulation at in-patient admission is associated with antidepressant therapy outcome in male but not in female depressed patients. Psychoneuroendocrinology. 2009;34(1):99-109.
Binder, E. B., Künzel, H. E., Nickel, T., Kern, N., Pfennig, A., Majer, M., ... Holsboer, F. (2009). HPA-axis regulation at in-patient admission is associated with antidepressant therapy outcome in male but not in female depressed patients. Psychoneuroendocrinology, 34(1), pp. 99-109. doi:10.1016/j.psyneuen.2008.08.018.
Binder EB, et al. HPA-axis Regulation at In-patient Admission Is Associated With Antidepressant Therapy Outcome in Male but Not in Female Depressed Patients. Psychoneuroendocrinology. 2009;34(1):99-109. PubMed PMID: 18829172.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - HPA-axis regulation at in-patient admission is associated with antidepressant therapy outcome in male but not in female depressed patients. AU - Binder,E B, AU - Künzel,H E, AU - Nickel,T, AU - Kern,N, AU - Pfennig,A, AU - Majer,M, AU - Uhr,M, AU - Ising,M, AU - Holsboer,F, Y1 - 2008/09/30/ PY - 2008/04/14/received PY - 2008/08/13/revised PY - 2008/08/20/accepted PY - 2008/10/3/pubmed PY - 2009/3/25/medline PY - 2008/10/3/entrez SP - 99 EP - 109 JF - Psychoneuroendocrinology JO - Psychoneuroendocrinology VL - 34 IS - 1 N2 - A concatenation of data implicates a hyperactivity of the hypothalamus pituitary adrenal (HPA)-axis in the pathogenesis of depression and its normalization as a necessary predecessor of clinical response to antidepressant drugs. In addition, regulation of the HPA-axis has been shown to be dependent on sex hormones. We therefore investigated gender differences in HPA-axis regulation in depression and its normalization during remission of clinical symptoms. We used the combined dexamethasone suppression/CRH stimulation (Dex-CRH) test to evaluate the degree of HPA-axis dysregulation in 194 in-patients with unipolar depression from the Munich Antidepressant Response Signature (MARS) study at both admission and discharge. The Hamilton Depression (HAM-D) Rating Scale was used to monitor clinical response to antidepressant treatment. For both genders, we observed a normalization of HPA-axis dysregulation in remitters but not in non-remitters, both after 5 weeks of treatment and at discharge. The pattern of HPA-axis normalization with remission of depressive symptoms, however, showed gender-specific differences. In male patients, remission after 5 weeks of in-patient treatment was associated with a significantly higher cortisol response in the Dex-CRH test at admission. In female patients, 5-week remitters and non-remitters had a comparable cortisol response at admission. Cortisol response at admission was not correlated with gonadal steroid levels at this time point and the results were similar for pre-menopausal women vs. post-menopausal women. Gender-associated biological characteristics, likely independent of circulating gonadal steroids, thus seem to influence HPA-axis regulation in depression. In male patients, a single measure of HPA-axis dysregulation at admission may serve as a predictor of response to antidepressant treatment in addition to the previously reported repeated measure of the Dex-CRH test. SN - 0306-4530 UR - https://www.unboundmedicine.com/medline/citation/18829172/HPA_axis_regulation_at_in_patient_admission_is_associated_with_antidepressant_therapy_outcome_in_male_but_not_in_female_depressed_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0306-4530(08)00220-5 DB - PRIME DP - Unbound Medicine ER -