Changes In HPA Axis Of Treatment-resistant Depression

Background:Major depression is a common mood disorder.The number of people with major depression worldwide is more than 350 million.About 20-30% of people with major depression are treatment-resistant depression.These patients have serious illness,long course of disease,and poor treatment,which cause a serious burden on families and society.Major depression is closely related to deregulations of the hypothalamic-pituitary-adrenal axis.Objective:The purpose of this study was to observe the difference in plasma cortisol concentrations between patients with treatment-resistant depression and non-treatment-resistant depression in non-first-onset patients before and after receiving dexamethasone suppression test.Analysis of HPA axis changes in patients with non-first treatment-resistant depression combined with patient HAMD score,HAMA score,and suicide score.Exploring the possible pathogenesis of treatment-resistant depression.Methods:According to the inclusion and exclusion criteria,eligible non-first-onset treatment-resistant depression patients and non-first-onset non-treatment-resistant depression patients were selected.General information collection,specialist examination,and HAMD,HAMA,and suicide scales were evaluated for both groups.Blood samples were drawn 3 ml at 08:00,16:00,23:00 on the first day after admission and the cortisol concentration was measured.At 23:30 on the first day after admission,both groups oral administration of dexamethasone 1 mg.Blood samples were drawn 3 ml at 08:00,16:00,23:00 on the second day after admission and the cortisol concentration was measured.Statistical analysis was performed using SPSS 25.0 software using various statistical methods.Results:Forty patients in the treatment-resistant depression group and the non-treatment-resistant depression group were enrolled.There were no significant differences in gender,age and BMI between the treatment-resistant group and the non-treatment-resistant group(P<0.05).The course of disease,HAMD,HAMA and suicide scores in the treatment-resistant group were higher than those in the non-treatment-resistant group,and the difference was statistically significant(P<0.05).A total of 6 cortisol concentration tests were obtained for all subjects,and the mean ± variance of cortisol at each time point and the mean ± variance of all subjects at each time point were calculated.The differences in the three levels of cortisol between the two groups were compared.The results showed that the three concentrations in the treatment-resistant group were higher than those in the non-treatment-resistant group(P<0.05).The difference in cortisol concentrations between the two groups after DST was compared.The results showed that the three concentrations in the treatment-resistant group were higher than those in the non-treatment-resistant group(P<0.05).Compared the concentrations of baseline and after DST.The three levels cortisol concentration after DST were lower than the baseline level(P < 0.05).The cortisol level after DST in the treatment-resistant group was lower than the baseline level(P<0.05).The cortisol concentration after DST in the non-treatment-resistant group was lower than the baseline level(P < 0.05).From the overall view of all subjects,three times cortisol concentration after DST was lower than the baseline level(P < 0.05).The cortisol level after DST in the treatment-resistant group was lower than the baseline level(P<0.05).The cortisol level after DST in the non-treatment-resistant group was lower than the baseline level(P<0.05).In the three measurements after DST,the number of people who had cortisol higher than 5 μg/dL in the treatment-resistant group was 29,and that in the non-treatment-resistant group was 17.Among all subjects,9 patients had cortisol below 5 μg/dL in three tests before DST,and 53 patients had cortisol below 5 μg/dL after DST.The cortisol concentration at 08:00 before DST was directly proportional to the HAMD score and suicide score in the treatment-resistant group and the suicide score in the non-treatment-resistant group.Cortisol concentration at 08:00 after DST was directly proportional to the HAMD score and suicide score in the treatment-resistant group,the HAMD score and the suicide score in the nontreatment-resistant group.Conclusion:In patients with non-first-onset depression,both treatment-resistant depression and non-treatment-resistant depression patients were not completely inhibited by the dexamethasone suppression test,and the proportion of patients with treatment-resistant depression was higher.In patients with non-first-episode depression,baseline levels of cortisol in patients with treatment-resistant depression were higher than those with non-treatment-resistant depression.In patients with non-first-episode depression,depressive symptoms in patients with treatment-resistant depression are associated with cortisol levels.