Mirtazapine does not influence tetrahydrodeoxycorticosterone levels in depressed patients

Abstract

Background. Among the neuroactive steroids, 3α,5α-tetrahydrodeoxycorticosterone (3α,5α-THDOC) is at least in part produced in the adrenal gland and is therefore under the control of the hypothalamic-pituitary-adrenocortical (HPA) system. The antidepressant mirtazapine has been shown to attenuate HPA axis activity and to increase the concentrations of 3α-reduced metabolites of progesterone in depressed patients. In the present study, the impact of mirtazapine on 3α,5α-THDOC levels was investigated in relation to clinical response in depressed patients. Method. A total of 23 drug-free inpatients suffering from a major depressive episode (DSM-IV criteria) underwent 5-week treatment with mirtazapine (45 mg/day). Plasma samples were taken weekly at 08:00 h and were quantified for 3α,5α-THDOC levels. Results. 3α,5α-THDOC levels were not correlated with demographic and clinical parameters such as age and severity of depression. Moreover, 5-week treatment with mirtazapine did not influence the 3α,5α-THDOC in the depressed patients, neither in responders nor in non-responders. Conclusion. Putative increasing effects of mirtazapine on 3α-reduced neuroactive steroids such as 3α,5α-THDOC which may be mediated via an impact on the neurosteroidogenic enzyme 3α-hydroxysteroid dehydrogenase seem to be counterbalanced by the mirtazapine-induced inhibition of ACTH secretion which directly influences the 3α,5α-THDOC release of the adrenal cortex.

• Antidepressants
• major depressive disorder
• unipolar major depression
• psychopharmacology