Background
Little is known about the hypothalamic–pituitary–adrenal (HPA) axis stress system
in chronic depression. This study examined the corticotropin-releasing hormone (CRH)
challenge test in a group of patients with chronic depression, before and after 3
months of treatment with vagus nerve stimulation (VNS) therapy, and a matched group
of healthy control subjects.
Methods
Key inclusion criteria were DSM-IV–defined major depressive disorder, a history of
a current episode lasting for at least 2 years, and unresponsiveness to at least two
classes of antidepressant medications. Eleven test subjects and 11 matched control
subjects underwent a CRH challenge.
Results
There were significant reductions in depression scores over the study period. The
CRH/ACTH (adrenocorticotropic hormone) responses in the depressed group before VNS
implantation were significantly higher than in the healthy group and were reduced
to normal values after VNS treatment. Some measures of cortisol response were elevated
before treatment and were reduced to normal over the study period. The only clinical
measure correlated with HPA axis alterations was reduction in atypical depressive
symptom scores.
Conclusions
These preliminary results suggest that chronic depression, in contrast to acute melancholic
depression, might be characterized by increased ACTH response to CRH challenge. Short-term
treatment with VNS therapy was associated with normalization of this response.
Key Words
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Article info
Publication history
Published online: July 08, 2005
Accepted:
April 26,
2005
Received in revised form:
February 28,
2005
Received:
September 22,
2004
Identification
Copyright
© 2005 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
