Hypothalamic-pituitary-adrenal (HPA) axis functioning as predictor of antidepressant response Meta-analysis

NEUROSCIENCE AND BIOBEHAVIORAL REVIEWS

卷:83

Review

Fischer, Susanne^1,2  Macare, Christine¹  Cleare, Anthony J.^1,3 

[1] Kings Coll London, Inst Psychiat Psychol & Neurosci, Dept Psychol Med, Ctr Affect Disorders, London, England

[2] Univ Zurich, Inst Psychol Clin Psychol & Psychotherapy, Binzmuehlestr 14,Box 26, CH-8050 Zurich, Switzerland

[3] South London & Maudsley NHS Fdn Trust, Denmark Hill, London, England

关键词: Antidepressant;    Cortisol;    Depression;    Hypothalamic-pituitary-adrenal axis;    Treatment response;   

DOI  :  10.1016/j.neubiorev.2017.10.012

来源: Elsevier

【 摘 要 】

Objective: Although antidepressants are effective, around 50% of depressed patients are non-responsive. At the same time, some patients show alterations in the hypothalamic-pituitary-adrenal (HPA) axis. Due to interactions with central monoaminergic systems, these may profit less from antidepressants. Method: To determine whether non-responders and responders differed in pre-treatment HPA axis functioning, the Cochrane Library, EMBASE, MEDLINE, and PsycINFO were searched. Studies using patients with depression being treated with antidepressants, and including both a pre-treatment HPA and a post-treatment response measure were included. Standardised mean differences were calculated for meta-analysis. Results: Thirty-nine studies were included. Non-responders and responders did not differ in pre-treatment corticotropin-releasing hormone or adrenocorticotropic hormone. Meta-regression showed non-responders had comparably higher pre-treatment cortisol in studies measuring cortisol non-invasively, not reporting sample storage, failing to control for age, and excluding patients with comorbidities. Conclusions: Only studies with a specific methodological profile seem to be able to show that the more marked depressed patients' alterations in the HPA axis, the less likely they are to profit from antidepressants.

【 授权许可】

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