Tolerability of the dexamethasone–corticotropin releasing hormone test in major depressive disorder

BackgroundThe dexamethasone–corticotropin releasing hormone (Dex–CRH) test may differentially predict which depressed patients will respond to antidepressant medication. However, a comprehensive analysis of the safety of this test in psychiatric patients has not previously been performed.MethodsWe conducted a pooled analysis of depressed patients in four clinical studies. Observed and subjectively reported side-effects in 454 patients were collected for 90 minutes following CRH administration. Pre-test electrocardiograms were available in 250 patients to assess cardiac safety. Descriptive statistics were performed to evaluate these safety data.ResultsEight-six (18.9%) subjects experienced no side-effects from the procedure. The mean number of side-effects per subject was 1.4 ± 1.0. The most frequent adverse events were: flushing (n = 216, 47.6%), feeling of warmth (144, 31.7%), hyperpnea/tachypnea (108, 23.8%), palpitations (37, 8.1%), and tachycardia (28, 6.2%). Side-effects were consistently mild and brief in duration. There were no serious adverse events.ConclusionThe Dex–CRH test produces a mild, predictable side-effect profile, characterized by flushing, feelings of warmth, hyperpnea/tachypnea, palpitations, and tachycardia. These results provide reassurance that the Dex–CRH test is well tolerated in psychiatric patients.