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Effects of lithium on the HPA axis in patients with unipolar major depression

Published online by Cambridge University Press:  16 April 2020

T. Bschor
Affiliation:
Dept. of Psychiatry, Schlosspark Clinic, Berlin Dept. of Psychiatry and Psychotherapy, Technical University of Dresden, Dresden
D. Ritter
Affiliation:
Dept. of Psychiatry and Psychotherapy, Technical University of Dresden, Dresden
U. Lewitzka
Affiliation:
Dept. of Psychiatry and Psychotherapy, Technical University of Dresden, Dresden
M. Bauer
Affiliation:
Dept. of Psychiatry and Psychotherapy, Technical University of Dresden, Dresden
M. Uhr
Affiliation:
Max Planck Institute of Psychiatry, Munich, Germany
M. Ising
Affiliation:
Max Planck Institute of Psychiatry, Munich, Germany

Abstract

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Background

  1. (I) Profound alterations of the hypothalamic-pituitary-adrenocortical (HPA) axis regulation were repeatedly shown in depressed patients. The most sensitive challenge test of the HPA axis, the combined dexamethasone/CRH test (DEX/CRH test), shows an overstimulation of ACTH and cortisol in depressed patients. Under tricyclic antidepressant treatment, a normalization of the HPA axis overdrive was found to precede the clinical improvement.

  2. (II) Lithium is a well established drug for the treatment of affective disorders. Yet, its exact mode of action and its effects on the HPA axis are still unknown.

Design and methods

Three 4-week studies with each 30 acutely depressed patients (unipolar, SCID I confirmed) were conducted. In study 1, patients refractory to a treatment trial with an antidepressant of at least four weeks were treated with lithium augmentation. In study 2 and 3, drug free patients were treated with lithium monotherapy or citalopram monotherapy respectively. Weekly HAM-D ratings were performed. In each study, the DEX/CRH test was conducted right before and four weeks after initiation of the pharmacotherapy.

Results

All three pharmacological strategies showed good antidepressive efficacy. Both lithium monotherapy and lithium augmentation led to a (for most parameters significant) increase in the HPA axis activity. In contrast, citalopram monotherapy resulted in a decrease of the hormone response to the DEX/CRH test.

Type
P02-18
Copyright
Copyright © European Psychiatric Association 2011
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