BACKGROUND: Abnormalities in the hypothalamic pituitary adrenal axis have been implicated in the pathophysiology of psychotic major depression (PMD). Recent studies have suggested that the antiglucocorticoid, mifepristone might have a role in the treatment of PMD. The current study tested the efficacy of mifepristone treatment of the psychotic symptoms of PMD. METHODS:221 patients, aged 19 to 75 years, who met DSM-IV and SCID criteria for PMD and were not receiving antidepressants orantipsychotics, participated in a double blind, randomized, placebo controlled study. Patients were randomly assigned to either 7 days of mifepristone (n = 105) or placebo (n = 116) followed by 21 days of usual treatment. RESULTS: Patients treated with mifepristone were significantly more likely to achieve response, defined as a 30% reduction in the Brief Psychiatric Rating Scale (BPRS). In addition, mifepristone treated patients were significantly more likely to achieve a 50% reduction in the BPRS Positive Symptom Scale (PSS). No significant differences were observed on measures of depression. CONCLUSION: A seven day course of mifepristone followed by usual treatment appears to be effective and well tolerated in the treatment of psychosis in PMD. This study suggests that the antiglucocorticoid, mifepristone, might represent an alternative to traditional treatments of psychosis in psychotic depression.
RCT Entities:
BACKGROUND:Abnormalities in the hypothalamic pituitary adrenal axis have been implicated in the pathophysiology of psychotic major depression (PMD). Recent studies have suggested that the antiglucocorticoid, mifepristone might have a role in the treatment of PMD. The current study tested the efficacy of mifepristone treatment of the psychotic symptoms of PMD. METHODS: 221 patients, aged 19 to 75 years, who met DSM-IV and SCID criteria for PMD and were not receiving antidepressants or antipsychotics, participated in a double blind, randomized, placebo controlled study. Patients were randomly assigned to either 7 days of mifepristone (n = 105) or placebo (n = 116) followed by 21 days of usual treatment. RESULTS:Patients treated with mifepristone were significantly more likely to achieve response, defined as a 30% reduction in the Brief Psychiatric Rating Scale (BPRS). In addition, mifepristone treated patients were significantly more likely to achieve a 50% reduction in the BPRS Positive Symptom Scale (PSS). No significant differences were observed on measures of depression. CONCLUSION: A seven day course of mifepristone followed by usual treatment appears to be effective and well tolerated in the treatment of psychosis in PMD. This study suggests that the antiglucocorticoid, mifepristone, might represent an alternative to traditional treatments of psychosis in psychotic depression.
Authors: Anna Lembke; Rowena Gomez; Lakshika Tenakoon; Jennifer Keller; Gregory Cohen; Gordon H Williams; Fredric B Kraemer; Alan F Schatzberg Journal: Psychoneuroendocrinology Date: 2012-06-21 Impact factor: 4.905
Authors: A Carlo Altamura; Marta Serati; Alessandra Albano; Riccardo A Paoli; Ira D Glick; Bernardo Dell'Osso Journal: Eur Arch Psychiatry Clin Neurosci Date: 2011-02-18 Impact factor: 5.270
Authors: Ioannis Zalachoras; René Houtman; Erika Atucha; Rene Devos; Ans M I Tijssen; Pu Hu; Peter M Lockey; Nicole A Datson; Joseph K Belanoff; Paul J Lucassen; Marian Joëls; E Ronald de Kloet; Benno Roozendaal; Hazel Hunt; Onno C Meijer Journal: Proc Natl Acad Sci U S A Date: 2013-04-23 Impact factor: 11.205