Hypothalamic-pituitary-adrenal (HPA) axis functioning as predictor of antidepressant response–Meta-analysis. (December 2017)

• Record Type: Journal Article
• Authors: Fischer, Susanne; Macare, Christine; Cleare, Anthony J.
• Is Part Of: Neuroscience and biobehavioral reviews. Volume 83(2017)
• Page Start: 200
• Page End: 211
• Publication Date: 2017-12
• Subjects: Antidepressant -- Cortisol -- Depression -- Hypothalamic-pituitary-adrenal axis -- Treatment response; Psychophysiology -- Periodicals; Human behavior -- Periodicals; Animal behavior -- Periodicals; Neurology -- Periodicals; Behavior -- Periodicals; Ethology -- Periodicals; Neurology -- Periodicals; Psychophysiologie -- Périodiques; Comportement humain -- Périodiques; Animaux -- Mœurs et comportement -- Périodiques; Neurologie -- Périodiques; Animal behavior; Human behavior; Neurology; Psychophysiology; Periodicals; Electronic journals; 573.8
• DOI: 10.1016/j.neubiorev.2017.10.012
• Languages: English
• ISSNs: 0149-7634

Abstract

Highlights: 39 studies investigated HPA functioning as a predictor of antidepressant response. Non-responders did not differ from responders in pre-treatment CRH and ACTH. Non-responders had higher cortisol in studies with a specific methodological profile. Abstract: 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.