The combined DEX-CRH test in treatment course and long-term outcome of major depression
The combined DEX-CRH test in treatment course and long-term outcome of major depression
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DOI：
10.1016/s0022-3956(02)00021-3
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发表时间：
2002-09-01
影响因子：
4.8
通讯作者：
Holsboer-Trachsler, E
中科院分区：
文献类型：
--
作者：
Hatzinger, M;Hemmeter, UM;Holsboer-Trachsler, E
神经内分泌研究表明，下丘脑-垂体-肾上腺皮质(HPA)系统在抑郁症的发生发展过程中起着至关重要的作用。然而，在长期病程中，疾病过程与HPA系统功能之间的相互作用尚不清楚。由于HPA系统恶化的改善已被证明与治疗反应有关，因此出现的问题是，例如早期改善或反应(在治疗1或2周后)所反映的治疗反应过程是否也基于HPA系统功能障碍，以及治疗期间HPA调节过程是否仅是一种状态标志，或对长期结果具有额外的预测意义。为了阐明这些问题，进行了一项长期研究，以调查HPA系统障碍是否与(1)急性抑郁症期间的治疗反应(主要是早期治疗反应)过程有关，以及(2)是否与长期抑郁过程(即发作次数)有关。20名情感性精神障碍患者参加了超过6周的早期对照抗抑郁药物治疗研究，他们被纳入探索性随访研究。应用DEX/CRH联合试验证实：(1)早期改善、早期治疗反应和6周后的有益治疗结果与HPA系统活性降低有关；(2)在抑郁症的长期病程中，HPA系统的恶化程度与既往发作次数平行增加。这些发现表明，HPA系统的改变与抑郁症的治疗反应和长期结局密切相关。(C)2002爱思唯尔科学有限公司。保留所有权利。
Neuroendocrine studies strongly suggest that the hypothalamic pituitary-adrenocortical (HPA) system plays a crucial role in the development and course of depression. The interaction between the disease process and HPA system function in long-term course, however, is unclear. Since improvement of HPA system deterioration has been demonstrated to be associated with treatment response, the question has arisen whether the course of therapy response as reflected by, for example, early improvement or response (after 1 or 2 weeks of therapy) is also based on HPA system dysfunction and whether the course of HPA regulation during treatment is only a state marker or has additional predictive implications for long-term outcome. In order to elucidate these questions a long-term study was carried out to investigate whether HPA system disturbance is associated (1) with the course of treatment response, predominantly early treatment response, during acute depression and (2) with the long-term course of depression, i.e. number of episodes. Twenty patients with affective disorders who participated in earlier controlled antidepressant treatment studies over 6 weeks were enrolled in an exploratory follow-up study. Using the combined DEX/CRH test it was demonstrated that (1) early improvement, early treatment response and beneficial treatment outcome after 6 weeks were associated with a lower HPA system activity and that (2) in long-term course of depression the HPA system deterioration increases in parallel with the number of previous episodes. These findings suggest that HPA system alterations are closely related to treatment response and long-term outcome of depression. (C) 2002 Elsevier Science Ltd. All rights reserved.