Prednisolone suppression test in depression: prospective study of the role of HPA axis dysfunction in treatment resistance

Mario F Juruena; Carmine M Pariante; Andrew S Papadopoulos; Lucia Poon; Stafford Lightman; Anthony J Cleare

doi:10.1192/bjp.bp.108.050278

Prednisolone suppression test in depression: prospective study of the role of HPA axis dysfunction in treatment resistance

Mario F Juruena, Carmine M Pariante, Andrew S Papadopoulos, Lucia Poon, Stafford Lightman, Anthony J Cleare

Research output: Contribution to journal › Article (Academic Journal)

Abstract

BACKGROUND: People with severe depressive illness have raised levels of cortisol and reduced glucocorticoid receptor function.

AIMS: To obtain a physiological assessment of hypothalamic-pituitary-adrenal (HPA) axis feedback status in an in-patient sample with depression and to relate this to prospectively determined severe treatment resistance.

METHOD: The prednisolone suppression test was administered to 45 in-patients with depression assessed as resistant to two or more antidepressants and to 46 controls, prior to intensive multimodal in-patient treatment.

RESULTS: The patient group had higher cortisol levels than controls, although the percentage suppression of cortisol output after prednisolone in comparison with placebo did not differ. Non-response to in-patient treatment was predicted by a more dysfunctional HPA axis (higher cortisol levels post-prednisolone and lower percentage suppression).

CONCLUSIONS: In patients with severe depression, HPA axis activity is reset at a higher level, although feedback remains intact. However, prospectively determined severe treatment resistance is associated with an impaired feedback response to combined glucocorticoid and mineralocorticoid receptor activation by prednisolone.

Original language	English
Pages (from-to)	342-9
Number of pages	8
Journal	British Journal of Psychiatry
Volume	194
Issue number	4
DOIs	https://doi.org/10.1192/bjp.bp.108.050278
Publication status	Published - Apr 2009

Keywords

Adolescent
Antidepressive Agents/therapeutic use
Case-Control Studies
Depressive Disorder/drug therapy
Drug Resistance/drug effects
England
Female
Glucocorticoids
Humans
Hydrocortisone/metabolism
Hypothalamo-Hypophyseal System/drug effects
Male
Pituitary-Adrenal System/drug effects
Prednisolone
Prospective Studies
Receptors, Glucocorticoid/metabolism
Severity of Illness Index
Treatment Outcome

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Juruena, M. F., Pariante, C. M., Papadopoulos, A. S., Poon, L., Lightman, S., & Cleare, A. J. (2009). Prednisolone suppression test in depression: prospective study of the role of HPA axis dysfunction in treatment resistance. British Journal of Psychiatry, 194(4), 342-9. https://doi.org/10.1192/bjp.bp.108.050278

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abstract = "BACKGROUND: People with severe depressive illness have raised levels of cortisol and reduced glucocorticoid receptor function.AIMS: To obtain a physiological assessment of hypothalamic-pituitary-adrenal (HPA) axis feedback status in an in-patient sample with depression and to relate this to prospectively determined severe treatment resistance.METHOD: The prednisolone suppression test was administered to 45 in-patients with depression assessed as resistant to two or more antidepressants and to 46 controls, prior to intensive multimodal in-patient treatment.RESULTS: The patient group had higher cortisol levels than controls, although the percentage suppression of cortisol output after prednisolone in comparison with placebo did not differ. Non-response to in-patient treatment was predicted by a more dysfunctional HPA axis (higher cortisol levels post-prednisolone and lower percentage suppression).CONCLUSIONS: In patients with severe depression, HPA axis activity is reset at a higher level, although feedback remains intact. However, prospectively determined severe treatment resistance is associated with an impaired feedback response to combined glucocorticoid and mineralocorticoid receptor activation by prednisolone.",

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author = "Juruena, {Mario F} and Pariante, {Carmine M} and Papadopoulos, {Andrew S} and Lucia Poon and Stafford Lightman and Cleare, {Anthony J}",

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Prednisolone suppression test in depression : prospective study of the role of HPA axis dysfunction in treatment resistance. / Juruena, Mario F; Pariante, Carmine M; Papadopoulos, Andrew S; Poon, Lucia; Lightman, Stafford; Cleare, Anthony J.

In: British Journal of Psychiatry, Vol. 194, No. 4, 04.2009, p. 342-9.

Research output: Contribution to journal › Article (Academic Journal)

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T1 - Prednisolone suppression test in depression

T2 - prospective study of the role of HPA axis dysfunction in treatment resistance

AU - Juruena, Mario F

AU - Pariante, Carmine M

AU - Papadopoulos, Andrew S

AU - Poon, Lucia

AU - Lightman, Stafford

AU - Cleare, Anthony J

PY - 2009/4

Y1 - 2009/4

N2 - BACKGROUND: People with severe depressive illness have raised levels of cortisol and reduced glucocorticoid receptor function.AIMS: To obtain a physiological assessment of hypothalamic-pituitary-adrenal (HPA) axis feedback status in an in-patient sample with depression and to relate this to prospectively determined severe treatment resistance.METHOD: The prednisolone suppression test was administered to 45 in-patients with depression assessed as resistant to two or more antidepressants and to 46 controls, prior to intensive multimodal in-patient treatment.RESULTS: The patient group had higher cortisol levels than controls, although the percentage suppression of cortisol output after prednisolone in comparison with placebo did not differ. Non-response to in-patient treatment was predicted by a more dysfunctional HPA axis (higher cortisol levels post-prednisolone and lower percentage suppression).CONCLUSIONS: In patients with severe depression, HPA axis activity is reset at a higher level, although feedback remains intact. However, prospectively determined severe treatment resistance is associated with an impaired feedback response to combined glucocorticoid and mineralocorticoid receptor activation by prednisolone.

AB - BACKGROUND: People with severe depressive illness have raised levels of cortisol and reduced glucocorticoid receptor function.AIMS: To obtain a physiological assessment of hypothalamic-pituitary-adrenal (HPA) axis feedback status in an in-patient sample with depression and to relate this to prospectively determined severe treatment resistance.METHOD: The prednisolone suppression test was administered to 45 in-patients with depression assessed as resistant to two or more antidepressants and to 46 controls, prior to intensive multimodal in-patient treatment.RESULTS: The patient group had higher cortisol levels than controls, although the percentage suppression of cortisol output after prednisolone in comparison with placebo did not differ. Non-response to in-patient treatment was predicted by a more dysfunctional HPA axis (higher cortisol levels post-prednisolone and lower percentage suppression).CONCLUSIONS: In patients with severe depression, HPA axis activity is reset at a higher level, although feedback remains intact. However, prospectively determined severe treatment resistance is associated with an impaired feedback response to combined glucocorticoid and mineralocorticoid receptor activation by prednisolone.

KW - Adolescent

KW - Antidepressive Agents/therapeutic use

KW - Case-Control Studies

KW - Depressive Disorder/drug therapy

KW - Drug Resistance/drug effects

KW - England

KW - Female

KW - Glucocorticoids

KW - Humans

KW - Hydrocortisone/metabolism

KW - Hypothalamo-Hypophyseal System/drug effects

KW - Male

KW - Pituitary-Adrenal System/drug effects

KW - Prednisolone

KW - Prospective Studies

KW - Receptors, Glucocorticoid/metabolism

KW - Severity of Illness Index

KW - Treatment Outcome

U2 - 10.1192/bjp.bp.108.050278

DO - 10.1192/bjp.bp.108.050278

M3 - Article (Academic Journal)

C2 - 19336786

VL - 194

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EP - 349

JO - British Journal of Psychiatry

JF - British Journal of Psychiatry

SN - 0007-1250

IS - 4

ER -