Cortisol response in the combined dexamethasone/CRH test as predictor of relapse in patients with remitted depression: a prospective study

The development and course of depression is causally linked to impairment o f central regulation of the hypothalamic-pituitary-adrenocortical (HPA) sys tem, Previous research documented that the combined dexamethasone/corticotr opin-releasing hormone (DEX/CRH) test identifies HPA dysfunction with high sensitivity. We evaluated the predictive validity For medium-term outcome o f the cortisol response in the combined DEX/CRH test in 74 remitted patient s previously suffering from major depressive disorder. Of the 74 patients. 61 remained in stable remission and 13 relapsed during the first 6 months a fter discharge From the hospital. Although the cortisol and ACTH responses in the DEX/CRH test did not differ between the two groups of patients on ad mission. the responses differed significantly just before discharge: (P < 0 .05). We defined two dichotomous variables as prediction rules indicating ( 1) the change between admission and discharge in the cortisol response to t he DEX/CRH test. and (2) the effect of the CRH infusion on cortisol as comp ared to the baseline lec el in the DEX/CRH test prior to discharge only. An elevated cortisol response in the DEX/CRH test was correlated with 3 four- to six-fold higher risk for relapse than in individuals with a normal cort isol response. The two proposed rules Fur predicting relapse within the fir st 6 months after discharge could be optimized by including age and gender. Hence. an exaggerated cortisol response in the combined DEX/CRH test predi cts the recurrence of depressive psychopathology. The test performance can be further optimized if gender and age are: taken into account. (C) 2001 El sevier science Ltd. All rights reserved.