BACKGROUND: Dysregulation of the hypothalamic-pituitary-adrenocortical (HPA) system is one of the best replicated pathophysiological findings in depression. However, studies on the influence of treatment on the HPA system have partly yielded inconsistent results. OBJECTIVE: To assess the effects of citalopram monotherapy on the HPA system of mainly drug naïve patients with major depression by means of the combined DEX/CRH test. METHODS: The DEX/CRH test was conducted twice in 30 patients (25 drug naïve for the index episode) with major depression (single episode or unipolar recurrent; SCID I- and II-confirmed): directly before the start of a citalopram monotherapy (day 0) and four weeks thereafter (day 28). RESULTS: Twenty-three patients responded (≥50% reduction in the HDRS(21)-score), and 17 of them also reached criteria of remission (HDRS ≤ 7). Baseline (dexamethasone-suppressed) and CRH-stimulated ACTH concentrations significantly decreased from day 0 to day 28. CRH-stimulated cortisol concentrations also fell, although not significantly, but baseline cortisol concentrations exhibited a significant increase from day 0 to day 28. CONCLUSIONS: The blunting of the ACTH response in the DEX/CRH test under citalopram is in line with what has been observed in most studies with antidepressants. However, the partial rise in cortisol concentrations indicates an increase in the sensitivity of the adrenal cortex to ACTH. State-dependent alterations in the volume and the ACTH responsiveness of the adrenal gland have repeatedly been reported in depressed subjects, which indicates the possibility that SSRIs such as citalopram might exhibit a direct or indirect effect on the adrenal cortex.
BACKGROUND: Dysregulation of the hypothalamic-pituitary-adrenocortical (HPA) system is one of the best replicated pathophysiological findings in depression. However, studies on the influence of treatment on the HPA system have partly yielded inconsistent results. OBJECTIVE: To assess the effects of citalopram monotherapy on the HPA system of mainly drug naïve patients with major depression by means of the combined DEX/CRH test. METHODS: The DEX/CRH test was conducted twice in 30 patients (25 drug naïve for the index episode) with major depression (single episode or unipolar recurrent; SCID I- and II-confirmed): directly before the start of a citalopram monotherapy (day 0) and four weeks thereafter (day 28). RESULTS: Twenty-three patients responded (≥50% reduction in the HDRS(21)-score), and 17 of them also reached criteria of remission (HDRS ≤ 7). Baseline (dexamethasone-suppressed) and CRH-stimulated ACTH concentrations significantly decreased from day 0 to day 28. CRH-stimulated cortisol concentrations also fell, although not significantly, but baseline cortisol concentrations exhibited a significant increase from day 0 to day 28. CONCLUSIONS: The blunting of the ACTH response in the DEX/CRH test under citalopram is in line with what has been observed in most studies with antidepressants. However, the partial rise in cortisol concentrations indicates an increase in the sensitivity of the adrenal cortex to ACTH. State-dependent alterations in the volume and the ACTH responsiveness of the adrenal gland have repeatedly been reported in depressed subjects, which indicates the possibility that SSRIs such as citalopram might exhibit a direct or indirect effect on the adrenal cortex.
Authors: Elizabeth I Flandreau; Chase H Bourke; Kerry J Ressler; Wylie W Vale; Charles B Nemeroff; Michael J Owens Journal: Psychoneuroendocrinology Date: 2012-12-23 Impact factor: 4.905
Authors: Hu Zhichao; Lam Wai Ching; Li Huijuan; Yao Liang; Wang Zhiyu; Huang Weiyang; Bian Zhaoxiang; Zhong L D Linda Journal: Sci Rep Date: 2021-05-17 Impact factor: 4.379
Authors: Paula Kopschina Feltes; Janine Doorduin; Hans C Klein; Luis Eduardo Juárez-Orozco; Rudi Ajo Dierckx; Cristina M Moriguchi-Jeckel; Erik Fj de Vries Journal: J Psychopharmacol Date: 2017-06-27 Impact factor: 4.153
Authors: Paula Kopschina Feltes; Erik Fj de Vries; Luis E Juarez-Orozco; Ewelina Kurtys; Rudi Ajo Dierckx; Cristina M Moriguchi-Jeckel; Janine Doorduin Journal: J Cereb Blood Flow Metab Date: 2017-12-22 Impact factor: 6.200
Authors: Sadia Anjum; M M A Shalahuddin Qusar; Mohammad Shahriar; Sardar Mohammad Ashraful Islam; Mohiuddin Ahmed Bhuiyan; Md Rabiul Islam Journal: Ther Adv Psychopharmacol Date: 2020-04-28