Longitudinal hypothalamic-pituitary-adrenal axis trait and state effects in recurrent depression

PSYCHONEUROENDOCRINOLOGY

卷:37

Article

Lok, Anja¹  Mocking, Roel J. T.¹  Ruhe, Henricus G.¹  Visser, Ieke¹  Koeter, Maarten W. J.¹  Assies, Johanna¹  Bockting, Claudi L. H.²  Olff, Miranda³  Schene, Aart H.¹ 

[1] Univ Amsterdam, Acad Med Ctr, Dept Psychiat, Program Mood Disorders, NL-1105 AZ Amsterdam, Netherlands

[2] Univ Groningen, Dept Clin & Expt Psychol, Groningen, Netherlands

[3] Univ Amsterdam, Acad Med Ctr, Dept Psychiat, Ctr Psychol Trauma, NL-1105 AZ Amsterdam, Netherlands

关键词: Depressive disorder;    Major;    Recurrence;    Hypothalamo-hypophyseal system;    Pituitary-adrenal system;    Glucocorticoids;    Saliva;    Cohort studies;    Case-control studies;    Randomized controlled trial;    Cognitive therapy;   

DOI  :  10.1016/j.psyneuen.2011.10.005

来源: Elsevier

【 摘 要 】

Background: Hypothalamic-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. Methods: We 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. Results: Patients 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). Conclusions: Our 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. (c) 2011 Elsevier Ltd. All rights reserved.

【 授权许可】

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