Longitudinal hypothalamic-pituitary-adrenal axis trait and state effects in recurrent depression
BackgroundHypothalamic-pituitary-adrenal (HPA)-axis hyperactivity has been observed in (recurrent) major depressive disorder (MDD), although inconsistently and mainly cross-sectional. Longitudinal studies clarifying state-trait issues are lacking. We aimed to determine whether HPA-axis (hyper)activity in recurrent MDD is: (I) reflecting a persistent trait, (II) influenced by depressive state, (III) associated with stress or previous episodes, (IV) associated with recurrence, and (V) influenced by cognitive therapy.MethodsWe included 187 remitted highly recurrent MDD-patients (mean number of previous episodes: 6.3), participating in a randomized-controlled-trial investigating the preventive effect of additional cognitive therapy on recurrence. In an add-on two-staged patient-control and prospective-cohort design, we first cross-sectionally compared patients' salivary morning and evening cortisol concentrations with 72 age- and sex-matched controls, and subsequently longitudinally followed-up the patients with repeated measures after three months and two years.ResultsPatients had higher cortisol concentrations than controls (p < .001), which did not change by MDD-episodes during follow-up. HPA-axis activity had no relation with daily hassles or childhood life events. Cortisol concentrations were lower in patients with more previous episodes (p = .047), but not associated with recurrence(s) during follow-up. Finally, randomly assigned cognitive therapy at study-entry enhanced cortisol declines over the day throughout the two-year follow-up (p = .052).ConclusionsOur results indicate that remitted recurrent MDD-patients have a persistent trait of increased cortisol concentrations, irrespective of stress. In combination with our finding that patients' cortisol concentrations do not change during new MDD-episodes (and thus not represent epiphenomenal or state-effects), our results support that hypercortisolemia fulfills the state-independence criterion for an endophenotype for recurrent depression.
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Reference:
Lok A,Mocking RJ,Ruhé HG,Visser I,Koeter MW,Olff M,Assies J,Bockting CLH,Schene AH, | 2012
Psychoneuroendocrinology | 37 | 7 | july | 892-902
http://www.psyneuen-journal.com/article/S0306-4530(11)00309-X/abstract
Psychoneuroendocrinology | 37 | 7 | july | 892-902
http://www.psyneuen-journal.com/article/S0306-4530(11)00309-X/abstract
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