BACKGROUND: One of the most enduring and replicated findings in biological psychiatry is activation of the hypothalamic-pituitary-adrenal (HPA) axis in a subset of patients with major depressive disorder. This review will discuss some of these findings and their pertinence to the assessment and treatment of depressed patients. METHOD: MEDLINE, PsychINFO, and Current Contents databases were searched for pertinent articles on the HPA axis in patients with depression. In addition, hand searches were conducted of references from these sources and abstracts from meetings and books on this topic. Articles that would provide an overview of major or interesting studies in the field were selected for inclusion. RESULTS: The data support that HPA axis activation is common in depressed patients. Frequently reported findings include elevated cortisol and corticotropin-releasing hormone (CRH), nonsuppression on the dexamethasone suppression test, a blunted adrenocorticotropic hormone (ACTH) response to CRH, and hippocampal volume reduction. Evidence of HPA axis activation appears to have prognostic value and is associated with increased risk of depression relapse and even suicide. CONCLUSION: Future research in this area will focus on a better understanding of the etiology and long-term consequences of HPA axis activation in depressed patients. In addition, medications that act on the HPA axis are currently in development and may be part of the psychiatrist's and primary care physician's pharmacopoeia in the near future.
BACKGROUND: One of the most enduring and replicated findings in biological psychiatry is activation of the hypothalamic-pituitary-adrenal (HPA) axis in a subset of patients with major depressive disorder. This review will discuss some of these findings and their pertinence to the assessment and treatment of depressedpatients. METHOD: MEDLINE, PsychINFO, and Current Contents databases were searched for pertinent articles on the HPA axis in patients with depression. In addition, hand searches were conducted of references from these sources and abstracts from meetings and books on this topic. Articles that would provide an overview of major or interesting studies in the field were selected for inclusion. RESULTS: The data support that HPA axis activation is common in depressedpatients. Frequently reported findings include elevated cortisol and corticotropin-releasing hormone (CRH), nonsuppression on the dexamethasone suppression test, a blunted adrenocorticotropic hormone (ACTH) response to CRH, and hippocampal volume reduction. Evidence of HPA axis activation appears to have prognostic value and is associated with increased risk of depression relapse and even suicide. CONCLUSION: Future research in this area will focus on a better understanding of the etiology and long-term consequences of HPA axis activation in depressedpatients. In addition, medications that act on the HPA axis are currently in development and may be part of the psychiatrist's and primary care physician's pharmacopoeia in the near future.
Authors: E Mervaala; J Föhr; M Könönen; M Valkonen-Korhonen; P Vainio; K Partanen; J Partanen; J Tiihonen; H Viinamäki; A K Karjalainen; J Lehtonen Journal: Psychol Med Date: 2000-01 Impact factor: 7.723
Authors: R T Malison; A Anand; G H Pelton; P Kirwin; L Carpenter; C J McDougle; G R Heninger; L H Price Journal: J Clin Psychopharmacol Date: 1999-10 Impact factor: 3.153
Authors: Nick Van Laeken; Glenn Pauwelyn; Robrecht Dockx; Benedicte Descamps; Boudewijn Brans; Kathelijne Peremans; Chris Baeken; Ingeborg Goethals; Christian Vanhove; Filip De Vos Journal: J Neural Transm (Vienna) Date: 2018-06-28 Impact factor: 3.575
Authors: Monica A Garcia; Xuan Li; Philip A Allen; Douglas L Delahanty; Maggie S Eppelheimer; James R Houston; Dawn M Johnson; Frank Loth; Jahangir Maleki; Sarel Vorster; Mark G Luciano Journal: Cerebellum Date: 2021-03-06 Impact factor: 3.847