Tolerability of the Dexamethasone-Corticotropin Releasing Hormone Test in Major Depressive Disorder

• Authors: Boadie W Dunlop, Emory University; Yara Betancourt, Emory University; Elisabeth B. Binder, Emory University; Christine Heim, Emory University; Florian Holsboer, Max Planck Institute of Psychiatry; Marcus Ising, Max Planck Institute of Psychiatry; Melissa McKenzie, Emory University; Tanja Mletzko, Emory University; Hildegard Pfister, Max Planck Institute of Psychiatry; Charles B. Nemeroff, University of Miami; W Edward Craighead, Emory University; Helen S Mayberg, Emory University
• Journal Title: Journal of Psychiatric Research
• Volume: Volume 45, Number 1
• Publisher: Elsevier | 2011-01, Pages 24-28
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.jpsychires.2010.04.020
• Subjects: Psychology, General; Health Sciences, Mental Health; Health Sciences, Medicine and Surgery
• Keywords: Cortisol; corticotropin releasing factor; predictor; adverse event; HPA axis; electrocardiogram

Abstract

Background The dexamethasone-corticotropin releasing hormone (Dex-CRH) test may differentially predict which depressed patients will respond to antidepressant medication. However, a comprehensive analysis of the safety of this test in psychiatric patients has not been previously been performed. Methods We conducted a pooled analysis of depressed patients in four clinical studies. Observed and subjectively reported side effects in 454 patients were collected for 90 minutes following CRH administration. Pre-test electrocardiograms were available in 250 patients to assess cardiac safety. Descriptive statistics were performed to evaluate these safety data. Results Eight-six (18.9%) of all subjects experienced no side effects from the procedure. The mean number of side effects per subject was 1.4 ± 1.0. The most frequent adverse events were: flushing (n=216, 47.6%), feeling of warmth (144, 31.7%), hyperpnea/tachypnea (108, 23.8%), palpitations (37, 8.1%), and tachycardia (28, 6.2%). Side effects were consistently mild and brief in duration. There were no serious adverse events. Conclusion The Dex-CRH test produces a mild, predictable side-effect profile, characterized by flushing, feelings of warmth, hyperpnea/tachypnea, palpitations, and tachycardia. These results provide reassurance that the Dex-CRH test is well tolerated in psychiatric patients.