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Attenuation of HPA axis
hyperactivity and simultaneous clinical deterioration in a depressed
patient treated with mirtazapine.
Schule C, Baghai
T, Zwanzger P, Rupprecht R.
Department of Psychiatry,
Ludwig-Maximilians-University, Nussbaumstrasse 7, 80336 Munich, Germany.
It has been suggested
that hypothalamic-pituitary-adrenal (HPA) system dysregulation plays an
important role in the pathophysiology of depression and that
normalization of HPA axis hyperactivity precedes successful treatment
with antidepressants. We report the case of a 61-year-old patient
suffering from a major depressive episode who underwent the combined
dexamethasone suppression/CRH stimulation test (DEX/CRH test) before and
again after one week of mirtazapine treatment. While the patient showed
a marked decrease of cortisol and ACTH secretion during the DEX/CRH test
within one week, a pronounced and ongoing deterioration of depressive
symptoms with suicidal thoughts occurred that was resistant to
antidepressant medication and had to be treated with electroconvulsive
therapy. Apparently, mirtazapine rapidly attenuates HPA axis
hyperactivity in depressed patients via direct pharmacoendocrinological
effects. However, this amelioration of HPA system dysregulation is not
necessarily accompanied by clinical improvement.
PMID: 12587193 [PubMed - indexed for