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Journal Article

Impact on cortisol and antidepressant efficacy of quetiapine and escitalopram in depression

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Nothdurfter,  Caroline
Max Planck Institute of Psychiatry, Max Planck Society;

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Uhr,  Manfred
Max Planck Institute of Psychiatry, Max Planck Society;

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Rupprecht,  Rainer
Max Planck Institute of Psychiatry, Max Planck Society;

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Citation

Sarubin, N., Nothdurfter, C., Schmotz, C., Wimmer, A.-M., Trummer, J., Lieb, M., et al. (2014). Impact on cortisol and antidepressant efficacy of quetiapine and escitalopram in depression. PSYCHONEUROENDOCRINOLOGY, 39, 141-151. doi:10.1016/j.psyneuen.2013.10.008.


Cite as: https://hdl.handle.net/11858/00-001M-0000-0026-B8E0-2
Abstract
Background: In this study, the impact of quetiapine fumarate extended release (QXR) and escitalopram (ESC) on HPA axis activity was investigated in depressed patients in relationship to antidepressant efficacy. Methods: In a randomized, open-label 5-week trial 60 inpatients suffering from major depression (DSM-IV criteria) were treated for 5 weeks with either QXR (300 mg/day) or ESC (10 mg/day). The dexamethasone/CRH (DEX/CRH) test was performed before treatment, after 1, and after 5 weeks of treatment. Cortisol (COR) AUC values were used to assess HPA axis function. The Hamilton Depression Rating Scale was used weekly to estimate antidepressant efficacy. Results: QXR and ESC showed comparable antidepressant effects but strongly differed in their impact on HPA axis activity. In the QXR group, a marked inhibition of COR AUC levels was observed which was most pronounced after one week of treatment but showed a partial re-increase after 5 weeks of treatment. In contrast, ESC transiently stimulated COR AUC values (week 1) whereas COR AUC levels at week 0 and week 5 were comparable. COR improvement at week 1 (defined as COR peak value reduction between DEX/CRH test 1 and 2) was significantly associated with better clinical outcome. Conclusion: Apparently, different effects on HPA axis activity reflect distinct pharmacoendocrinological properties of psychotropic drugs. (C) 2013 Elsevier Ltd. All rights reserved.