The role of mineralocorticoid receptor function in treatment-resistant depression

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

Research output: Contribution to journalArticle (Academic Journal)peer-review

51 Citations (Scopus)


BACKGROUND: Treatment-resistant depression patients show both reduced glucocorticoid receptor function and a hyperactive hypothalamic-pituitary-adrenal axis. However, few studies have examined the role of the mineralocorticoid receptor. This study aimed to evaluate the functional activity of the mineralocorticoid receptor system in regulating the hypothalamic-pituitary-adrenal axis in well-defined treatment-resistant depression patients.

MATERIAL AND METHOD: We recruited 24 subjects divided into: (a) treatment-resistant depression; (b) healthy controls. We evaluated: (a) the effect of combined glucocorticoid receptor/mineralocorticoid receptor stimulation with prednisolone; (b) the effect of prednisolone with the mineralocorticoid receptor antagonist spironolactone; and (c) the effect of spironolactone alone. The response of the hypothalamic-pituitary-adrenal axis was measured using salivary cortisol and plasma levels of drugs were also measured.

RESULTS: Treatment-resistant depression patients had higher cortisol compared with controls after all challenges. In controls, spironolactone increased cortisol compared to placebo. The co-administration of spironolactone with prednisolone in controls decreases the suppressive effects of prednisolone. In contrast, in treatment-resistant depression, spironolactone did not increase cortisol compared to placebo and spironolactone with prednisolone had no effect on the suppressive effects of prednisolone. Patients with treatment-resistant depression had a reduction in the conversation of spironolactone to the active metabolite canrenone.

CONCLUSION: Our data confirmed that treatment-resistant depression is associated with hypercortisolism and these patients no longer show an hypothalamic-pituitary-adrenal response to the administration of a mineralocorticoid receptor antagonist, suggesting that there is a mineralocorticoid receptor malfunctioning, such as a down regulation, however, pharmacokinetics and pharmacodynamics in these subjects could also have had an effect on the lack of mineralocorticoid receptor response.

Original languageEnglish
Pages (from-to)1169-79
Number of pages11
JournalJournal of Psychopharmacology
Issue number12
Publication statusPublished - Dec 2013


  • Canrenone/metabolism
  • Case-Control Studies
  • Depressive Disorder, Treatment-Resistant/physiopathology
  • Female
  • Humans
  • Hydrocortisone/metabolism
  • Hypothalamo-Hypophyseal System/metabolism
  • Male
  • Middle Aged
  • Mineralocorticoid Receptor Antagonists/administration & dosage
  • Pituitary-Adrenal System/metabolism
  • Prednisolone/administration & dosage
  • Receptors, Glucocorticoid/drug effects
  • Receptors, Mineralocorticoid/drug effects
  • Saliva/chemistry
  • Single-Blind Method
  • Spironolactone/administration & dosage


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