Experts Question Effectiveness of Cortisol Blocker in Depressed Patients

Metyrapone is equivalent to placebo in “real life” study

It is well recognized that stress can lead to episodes of depressive illness and that some depressed patients have elevated levels of the stress hormone cortisol as an indication of their mental health. A study conducted at Newcastle University in the United Kingdom has shown that a drug that blocks the production of cortisol does not routinely help in treating depression. The findings were published in Lancet Psychiatry.

The new study examined the effectiveness of metyrapone (Metopirone, Novartis) in patients who had not responded to at least two conventional antidepressant drugs. The investigators found that common use of anticortisol drugs is ineffective for patients who have not responded to traditional treatments and that there is a need to search for better treatment options to deal with the condition.

Dr. Hamish McAllister-Williams, one of the leaders of the three-year study, said: “Our research has shown that, in the population of depressed patients studied, metyrapone is inadequate and therefore should not be routinely recommended as an option for treatment-resistant depression. We can’t rule out, however, that there might be some patients with particularly high levels of cortisol who might be helped by anticortisol treatment –– but this needs to be specifically tested in a clinical trial.”

A total of 165 depressed patients being treated by general practitioners or psychiatrists in Northern England were randomly assigned to treatment with either metyrapone or placebo in addition to their ongoing conventional antidepressants. The aim of study was to examine the efficacy, safety, and tolerability of metyrapone as a therapeutic option in everyday clinical practice. The primary clinical outcome was improvement in the Montgomery–Åsberg Depression Rating Scale (MADRS) score five weeks after randomization.

A total of 143 patients completed the primary outcome assessment (69 in the metyrapone group and 74 in the placebo group). At five weeks, the MADRS scores did not significantly differ between the two treatment groups (21.7 points for metyrapone vs. 22.6 points for placebo; P = 0.74).

Sources: Newcastle University; January 20, 2016; and Lancet Psychiatry; December 23, 2015.