Prediction of medium-term outcome by cortisol response to the combined dexamethasone-CRH test in patients with remitted depression

Objective: Current hypotheses hold that mechanisms underlying abnormal hypo thalamic-pituitary-adrenocortical (HPA) function are causal factors in the precipitation of depression. If this is the case, then normalization of ini tially disturbed HPA regulation should indicate a good prognosis and persis tent HPA dysregulation should be associated with a greater likelihood of re lapse or chronicity. Method: The combined dexamethasone/corticotropin-relea sing hormone test was administered twice to inpatients with major depressio n (N=40), once after initiation of treatment and once after remission, shor tly before discharge. Results: Patients with a high cortisol response on bo th occasions or with a substantially increased cortisol response at dischar ge were at much higher risk for relapse within the next 6 months than those with low cortisol responses. Conclusions: An easy-to-administer neuroendoc rine test allows the prediction of medium-term outcome in patients with rem itted depression.