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Wang R, Kogler L, Derntl B. Sex differences in cortisol levels in depression: A systematic review and meta-analysis. Front Neuroendocrinol 2024; 72:101118. [PMID: 38176541 DOI: 10.1016/j.yfrne.2023.101118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 12/11/2023] [Accepted: 12/31/2023] [Indexed: 01/06/2024]
Abstract
Higher prevalence of depression in females might be associated with sex-specific cortisol levels. Evidence exists that cortisol levels differ between healthy females and males, however a sex-specific association in depression has not been systematically assessed. Thus, the current study quantifies the existing literature on different cortisol parameters, i.e., basal cortisol, hair cortisol, cortisol awakening response (CAR), and cortisol stress reactivity comparing depressed females and males as well as sex-specific comparisons with healthy controls. Following an extensive literature research, fifty original articles were included. Depressed females had significantly higher hair cortisol, higher CAR, and lower cortisol stress reactivity compared to depressed males. In comparison with sex-matched controls, female patients had significantly higher evening basal cortisol, higher CAR and lower cortisol stress reactivity, and male patients had significantly higher general, morning and evening basal cortisol. Overall, sex as a fundamental driver of cortisol levels in depression needs to be taken into account.
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Affiliation(s)
- Rui Wang
- Department of Psychiatry and Psychotherapy, Women's Mental Health & Brain Function, Tübingen Center for Mental Health (TüCMH), Medical Faculty, University of Tübingen, Calwerstraße 14, 72076 Tübingen, Germany.
| | - Lydia Kogler
- Department of Psychiatry and Psychotherapy, Women's Mental Health & Brain Function, Tübingen Center for Mental Health (TüCMH), Medical Faculty, University of Tübingen, Calwerstraße 14, 72076 Tübingen, Germany; German Center for Mental Health (DZPG), partner site Tübingen, 72076 Tübingen, Germany
| | - Birgit Derntl
- Department of Psychiatry and Psychotherapy, Women's Mental Health & Brain Function, Tübingen Center for Mental Health (TüCMH), Medical Faculty, University of Tübingen, Calwerstraße 14, 72076 Tübingen, Germany; German Center for Mental Health (DZPG), partner site Tübingen, 72076 Tübingen, Germany; LEAD Graduate School and Research Network, University of Tübingen, Germany
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Song X, Cui W, Peng Z, Zhao L, Yu X, Li T, Cui L, Ma X. An initial exploration of hair cortisol responses to antidepressants in unmedicated patients with depression. J Int Med Res 2019; 48:300060519889431. [PMID: 31849246 PMCID: PMC7604987 DOI: 10.1177/0300060519889431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Major depressive disorder is associated with abnormal functioning of the hypothalamic-pituitary-adrenal (HPA) axis. Studies using hair cortisol to measure the effect of antidepressants on the HPA axis are lacking. The aim of this study was to explore the long-term effects of antidepressants on hair cortisol concentration (HCC). METHODS Participants were 42 patients and 36 healthy individuals. The patients took antidepressants for 4 weeks. Patient HCC was measured pre-treatment and post-treatment. The HCC of healthy controls was also measured. RESULTS Patient post-treatment HCC (mean ± standard deviation: 34.40 ± 32.57 pmol/mg) was significantly higher than patient pre-treatment HCC (17.42 ± 12.40 pmol/mg) and healthy control HCC (10.22 ± 7.99 pmol/mg). No significant correlation was found between Hamilton Depression Rating Scale scores and HCC at pre-treatment or post-treatment. CONCLUSIONS Hair cortisol concentration analysis could be used to monitor the dynamics of the effects of antidepressants on the HPA axis.
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Affiliation(s)
- Xiuli Song
- Psychiatric Laboratory and Department of Psychiatry, West China Hospital, Sichuan University, Chengdu, P. R. China.,Clinical Psychology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, P. R. China
| | - Wei Cui
- Mental Health Center of Hebei Province, Baoding, P. R. China
| | - Zugui Peng
- Psychiatric Laboratory and Department of Psychiatry, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Liansheng Zhao
- Psychiatric Laboratory and Department of Psychiatry, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Xuezhu Yu
- Mental Health Center of Hebei Province, Baoding, P. R. China
| | - Tao Li
- Psychiatric Laboratory and Department of Psychiatry, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Lijun Cui
- Mental Health Center of Hebei Province, Baoding, P. R. China
| | - Xiaohong Ma
- Psychiatric Laboratory and Department of Psychiatry, West China Hospital, Sichuan University, Chengdu, P. R. China
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Vargas I, Mayer S, Lopez-Duran N. The Cortisol Awakening Response and Depressive Symptomatology: The Moderating Role of Sleep and Gender. Stress Health 2017; 33:199-210. [PMID: 27465684 DOI: 10.1002/smi.2691] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 06/08/2016] [Accepted: 06/09/2016] [Indexed: 11/07/2022]
Abstract
The association between depression and the cortisol awakening response (CAR) has been widely examined, yet the results are mixed and factors responsible for such inconsistencies are poorly understood. The current study investigated whether the link between depressive symptomatology and CAR varied as a function of two such factors: sleep and gender. The sample included 58 young adults (30 females; Mage = 18.7; SDage = 0.91). Participants completed the Beck Depression Inventory as well as the Consensus Sleep Diary to assess depressive symptomatology and daily sleep patterns, respectively. Participants also provided four salivary cortisol samples (0, 30, 45 and 60 min after awakening) during two consecutive weekdays. Results demonstrated that greater depressive symptoms were associated with a greater CAR but only when depressive symptoms were linked to a shorter sleep time. In addition, gender significantly moderated the association between depressive symptoms and CAR. While greater depressive symptoms were associated with an elevated CAR among females, they were associated with a blunted CAR among males. These findings provide some insight into potential mechanisms linking depressive symptomatology and CAR, and suggest that future studies examining CAR as a biomarker of depression should account for differences in sleep and gender. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Ivan Vargas
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Stefanie Mayer
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
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Pochigaeva K, Druzhkova T, Yakovlev A, Onufriev M, Grishkina M, Chepelev A, Guekht A, Gulyaeva N. Hair cortisol as a marker of hypothalamic-pituitary-adrenal Axis activity in female patients with major depressive disorder. Metab Brain Dis 2017; 32:577-583. [PMID: 28064407 DOI: 10.1007/s11011-017-9952-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 01/03/2017] [Indexed: 01/03/2023]
Abstract
Hair cortisol is regarded as a promising marker of hypothalamic-pituitary-adrenal axis (HPAA) activity alterations due to stress, somatic and mental health conditions. Hair cortisol was previously reported to be elevated in patients with depression, however the data related to remission and recurrent depressive episodes are different. In this study, levels of hair cortisol were assessed in female patients with major depressive disorder (MDD) and the validity of hair cortisol as a marker of HPAA activity in this condition was evaluated. Hair cortisol was measured in 1 cm hair segments of 21 female patients with MDD and 22 female age-matched controls using enzyme-immunoassay analysis. Concurrently, serum cortisol was assessed and psychological status was evaluated using 17-item Hamilton Depression Rating Scale (HAMD-17), Beck Depression Inventory (BDI) and the Spielberger state trait anxiety inventory (STAI). The levels of hair cortisol were significantly lower in the MDD group, while serum cortisol levels were significantly higher in patients, as compared with controls. A significant negative correlation was found between HAMD-17 scores and hair cortisol. Decreased hair cortisol found in female patients with MDD as compared to controls suggests downregulation of HPAA activity during the preceding month. Further studies are needed to investigate the profiles of hair cortisol at different stages of depressive disorder to establish this parameter as a handy clinical tool.
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Affiliation(s)
- Ksenia Pochigaeva
- Healthcare Department of Moscow, Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - Tatiana Druzhkova
- Healthcare Department of Moscow, Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - Alexander Yakovlev
- Healthcare Department of Moscow, Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
- Department of Functional Biochemistry of the Nervous System, Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Butlerova street 5a, Moscow, 117485, Russia
| | - Mikhail Onufriev
- Healthcare Department of Moscow, Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
- Department of Functional Biochemistry of the Nervous System, Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Butlerova street 5a, Moscow, 117485, Russia
| | - Maria Grishkina
- Healthcare Department of Moscow, Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - Aleksey Chepelev
- Healthcare Department of Moscow, Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - Alla Guekht
- Healthcare Department of Moscow, Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
- Department of Neurology, Neurosurgery and Medical Genetics, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Natalia Gulyaeva
- Healthcare Department of Moscow, Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia.
- Department of Functional Biochemistry of the Nervous System, Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Butlerova street 5a, Moscow, 117485, Russia.
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Analysis of hair cortisol level in first-episodic and recurrent female patients with depression compared to healthy controls. J Affect Disord 2015; 175:299-302. [PMID: 25661395 DOI: 10.1016/j.jad.2015.01.023] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 01/14/2015] [Accepted: 01/14/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUND Although accumulating evidence has shown increased cortisol levels in serum, saliva, or 24-h urine samples in depression, a number of studies did not find the association between cortisol levels and depression. Hair cortisol levels reflect long-term and historical information of cortisol and hair cortisol analysis has been applied in the research of psychiatric diseases. The aim of this study is to compare the hair cortisol levels between patients with depression and healthy controls. METHODS Hair cortisol levels of 22 first-episodic and 13 recurrent female patients with depression and 30 healthy controls were measured and compared using the electrochemiluminescence immunoassay. The relationship between hair cortisol levels and Hamilton depression scale (HAMD) or Hamilton anxiety scale (HAMA) scores were also examined. RESULTS Before disease episode, no significant differences were observed among healthy controls, first-episodic patients and recurrent patients. In disease episode, the hair cortisol level in first-episodic patients was significantly higher than that in healthy controls or recurrent patients, while no significant difference was observed between recurrent patients and healthy controls. No significant correlation was found between HAMD or HAMA scores and hair cortisol levels in patients. LIMITATIONS First, long-term effects of antidepressants on the results cannot be excluded without detailed medication information of the recurrent patients. Second, sample sizes might be relatively small. CONCLUSIONS Our results indicate that hair cortisol levels increased in disease episode in first-episodic, but not recurrent patients with depression, which may suggest that episodes of disease have influence on cortisol levels.
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Lopez-Duran NL, McGinnis E, Kuhlman K, Geiss E, Vargas I, Mayer S. HPA-axis stress reactivity in youth depression: evidence of impaired regulatory processes in depressed boys. Stress 2015; 18:545-53. [PMID: 26115161 PMCID: PMC5403248 DOI: 10.3109/10253890.2015.1053455] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Given the link between youth depression and stress exposure, efforts to identify related biomarkers have involved examinations of stress regulation systems, including the hypothalamic-pituitary-adrenal (HPA) axis. Despite these vast efforts, the underlying mechanisms at play, as well as factors that may explain heterogeneity of past findings, are not well understood. In this study, we simultaneously examined separate components of the HPA-axis response (e.g. activation intensity, peak levels, recovery) to the Socially Evaluated Cold-Pressor Test in a targeted sample of 115 youth (age 9-16), recruited to overrepresent youth with elevated symptoms of depression. Among youth who displayed a cortisol response to the task, depression symptoms were associated with higher peak responses but not greater rate of activation or recovery in boys only. Among those who did not respond to the task, depression symptoms were associated with greater cortisol levels throughout the visit in boys and girls. Results suggest that depression symptoms are associated with a more prolonged activation of the axis and impaired recovery to psychosocial stressors primarily in boys. We discussed two potential mechanistic explanations of the link between depression symptoms and the duration of activation: (1) inhibitory shift (i.e. point at which the ratio of inhibitory and excitatory input into the axis shifts from greater excitatory to greater inhibitory input) or (2) inhibitory threshold (i.e. level of cortisol exposure required to activate the axis' feedback inhibition system).
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Affiliation(s)
| | - Ellen McGinnis
- a Department of Psychology , University of Michigan , Ann Arbor , MI , USA
| | - Kate Kuhlman
- a Department of Psychology , University of Michigan , Ann Arbor , MI , USA
| | - Elisa Geiss
- a Department of Psychology , University of Michigan , Ann Arbor , MI , USA
| | - Ivan Vargas
- a Department of Psychology , University of Michigan , Ann Arbor , MI , USA
| | - Stefanie Mayer
- a Department of Psychology , University of Michigan , Ann Arbor , MI , USA
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Vilela LHM, Juruena MF. Avaliação do funcionamento do eixo HPA em deprimidos por meio de medidas basais: revisão sistemática da literatura e análise das metodologias utilizadas. JORNAL BRASILEIRO DE PSIQUIATRIA 2014. [DOI: 10.1590/0047-2085000000031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objetivo Realizar revisão sistemática da literatura para conhecer a atividade do eixo hipotálamo-pituitária-adrenal (HPA) em deprimidos considerando-se as medidas basais dos hormônios e analisar criticamente as metodologias utilizadas. Métodos Foi realizada busca de artigos nas bases de dados PubMed e SciELO. Na primeira base de dados, introduziram-se as palavras-chave “depressive disorder” e “HPA axis”, e na segunda utilizaram-se os termos “depression” ou “depressão” e “HHA” ou “HPA axis”. Optou-se por pesquisa realizada em humanos adultos, em inglês e português, do ano 2000 até 2011. Resultados Dos 27 artigos selecionados, obtiveram-se como resposta do eixo HPA tanto hiperatividade como atividade desregulada, hipoatividade ou não alteração. Tais resultados dependem das variáveis e dos hormônios estudados, do fluido coletado – plasma, urina, saliva, líquido cefalorraquidiano – do horário de coleta, do número de coletas, da análise estatística utilizada, do subtipo de doença depressiva, entre outros. Conclusão: Os resultados não apresentam consenso em relação à atividade do eixo HPA. Considerando as variáveis estudadas, o eixo HPA, na maioria das vezes, apresenta-se disfuncional na presença da depressão.
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Hartman CA, Hermanns VW, de Jong PJ, Ormel J. Self- or parent report of (co-occurring) internalizing and externalizing problems, and basal or reactivity measures of HPA-axis functioning: a systematic evaluation of the internalizing-hyperresponsivity versus externalizing-hyporesponsivity HPA-axis hypothesis. Biol Psychol 2013; 94:175-84. [PMID: 23735709 DOI: 10.1016/j.biopsycho.2013.05.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Revised: 04/28/2013] [Accepted: 05/14/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous research findings on the link between adolescents' psychopathology and hypothalamic-pituitary-adrenal (HPA) axis activity have been heterogeneous. METHOD Adolescents (n=211) with a preadolescent DSM-IV diagnosis participated in a lab-based social stress task. Saliva cortisol was assessed at awakening and during social stress. It was investigated if continuous measures of internalizing and externalizing problems and their interaction, using both self- and parent report, were associated with basal or reactivity measures of HPA-axis functioning. RESULTS During social stress, an enhanced total release of cortisol was associated with self-reported internalizing problems and a blunted total release of cortisol with self-reported externalizing problems. Post hoc analyses revealed that the association between enhanced cortisol output and internalizing problems held for boys but not for girls. Associations with morning cortisol measures were overall weak. CONCLUSIONS Only in the context of stress, and particularly when based on self-report, blunted cortisol output was associated with externalizing and enhanced cortisol output with internalizing problems. Our broad approach demonstrates the importance of who reports on psychopathology, the use of dimensional measures of psychopathology, simultaneous analysis of internalizing and externalizing problems, and the use of awakening and social stress related measures of cortisol.
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Affiliation(s)
- Catharina A Hartman
- Interdisciplinary Center for Psychiatric Epidemiology, Department of Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
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Hinkelmann K, Botzenhardt J, Muhtz C, Agorastos A, Wiedemann K, Kellner M, Otte C. Sex differences of salivary cortisol secretion in patients with major depression. Stress 2012; 15:105-9. [PMID: 21790344 DOI: 10.3109/10253890.2011.582200] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Depression is associated with increased cortisol secretion and occurs more often in women than in men. Thus, it has been hypothesized that differences in cortisol secretion might, in part, be responsible for the greater risk of developing depression in women. However, only few studies have examined sex differences in baseline cortisol secretion in depressed patients and healthy controls. We examined sex effects on cortisol secretion in 52 medication-free patients with major depression (37 women, 15 men, mean ± SD age 35 ± 11 years, Hamilton Depression Scale mean score 27 ± 5) and 50 healthy age- and sex-matched control subjects. Salivary cortisol concentrations were measured at 8:00, 12:00, 16:00, and 22:00 h. Repeated measures analysis of covariance revealed a group × sex interaction (p = 0.05). Post hoc tests revealed higher cortisol concentrations in depressed compared to healthy men [F(1;29) = 7.5, p = 0.01]. No differences were found between depressed and non-depressed women. Our results do not support the hypothesis that differences in cortisol secretion between depressed and non-depressed subjects are more pronounced in women than in men. Study characteristics and methods as well as sex-specific confounding variables such as menstrual cycle, menopause and the use of oral contraceptives may account for inconclusive results across studies.
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Affiliation(s)
- Kim Hinkelmann
- Department of Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf Hamburg, Germany.
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Velders FP, Kuningas M, Kumari M, Dekker MJ, Uitterlinden AG, Kirschbaum C, Hek K, Hofman A, Verhulst FC, Kivimaki M, Van Duijn CM, Walker BR, Tiemeier H. Genetics of cortisol secretion and depressive symptoms: a candidate gene and genome wide association approach. Psychoneuroendocrinology 2011; 36:1053-61. [PMID: 21316860 PMCID: PMC3940151 DOI: 10.1016/j.psyneuen.2011.01.003] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 12/08/2010] [Accepted: 01/07/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND Depressive patients often have altered cortisol secretion, but few studies have investigated genetic variants in relation to both cortisol secretion and depression. To identify genes related to both these conditions, we: (1) tested the association of single nucleotide polymorphisms (SNPs) in hypothalamic-pituitary-adrenal-axis (HPA-axis) candidate genes with a summary measure of total cortisol secretion during the day (cortisol(AUC)), (2) performed a genome wide association study (GWAS) of cortisol(AUC), and (3) tested the association of identified cortisol-related SNPs with depressive symptoms. METHODS We analyzed data on candidate SNPs for the HPA-axis, genome-wide scans, cortisol secretion (n=1711) and depressive symptoms (the Centre for Epidemiology Studies Depression Scale, CES-D) (n=2928) in elderly persons of the Rotterdam Study. We used data from the Whitehall II study (n=2836) to replicate the GWAS findings. RESULTS Of the 1456 SNPs in 33 candidate genes, minor alleles of 4 SNPs (rs9470080, rs9394309, rs7748266 and rs1360780) in the FKBP5 gene were associated with a decreased cortisol(AUC) (p<1×10(-4) after correction for multiple testing using permutations). These SNPs were also associated with an increased risk of depressive symptoms (rs9470080: OR 1.19 (95%CI 1.0; 1.4)). The GWAS for cortisol yielded 2 SNPs with p-values of 1×10(-06) (rs8062512, rs2252459), but these associations could not be replicated. CONCLUSIONS These results suggest that variation in the FKBP5 gene is associated with both cortisol(AUC) and the likelihood of depressive symptoms.
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Affiliation(s)
- Fleur P. Velders
- Department of Child and Adolescent Psychiatry, Erasmus Medical Centre – Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Maris Kuningas
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
,Netherlands Genomics Initiative (NGI) sponsored Netherlands Consortium for Healthy Aging (NCHA).
| | - Meena Kumari
- Department of Epidemiology and Public Health, University College London, United Kingdom
| | - Marieke J. Dekker
- Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands.
| | - Andre G. Uitterlinden
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
,Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands.
,Netherlands Genomics Initiative (NGI) sponsored Netherlands Consortium for Healthy Aging (NCHA).
| | | | - Karin Hek
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
,Department of Psychiatry, Erasmus Medical Centre, Rotterdam, the Netherlands.
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
,Netherlands Genomics Initiative (NGI) sponsored Netherlands Consortium for Healthy Aging (NCHA).
| | - Frank C. Verhulst
- Department of Child and Adolescent Psychiatry, Erasmus Medical Centre – Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, United Kingdom
| | - Cornelia M. Van Duijn
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
,Netherlands Genomics Initiative (NGI) sponsored Netherlands Consortium for Healthy Aging (NCHA).
| | - Brian R Walker
- Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom.
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry, Erasmus Medical Centre – Sophia Children’s Hospital, Rotterdam, The Netherlands
,Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
,Netherlands Genomics Initiative (NGI) sponsored Netherlands Consortium for Healthy Aging (NCHA).
,Correspondence to: Department of Epidmiology, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, Tel.: +31 10 703 2183, Fax: +31 704 4465,
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Abstract
OBJECTIVE To determine whether there is a relationship between depressive symptoms and cortisol assessed at first morning awakening, 6 PM, and 9 PM in a population-based sample of midlife women. If this relationship is not linear, we aim to test whether this relationship is nonlinear, only present in those with more severe depressive symptoms, better accounted for by diurnal slope, or only apparent under uncontaminated conditions. METHODS We investigated the cross-sectional association between cortisol and depressive symptoms, assessed by the Center for Epidemiological Studies Depression scale (CES-D) in 408 midlife women (45.7% African Americans, 54.3% white; mean age, 50.4 years) participating in the Chicago site of the Study of Women's Health Across the Nation. RESULTS Diurnal cortisol slope is significantly flatter for women with higher CES-D scores than for less depressed women (p < .05 for the interaction). This relationship remains significant even after adjusting for age, smoking status, race, education, income, menopausal status, hormone replacement therapy, body mass index, medications, and wake time, as well as possibly contaminating factors, including physical activity, smoking, eating, or caffeine or alcohol consumption before saliva collection. Results using depression assessed categorically (CES-D cutoff ≥16) were similar to those using continuous depression in both unadjusted and adjusted analyses (p = .005 for the interaction of CES-D by time). CONCLUSIONS In this population-based sample of midlife women, greater depressive symptoms were associated with a significantly flatter diurnal cortisol slope than those with fewer symptoms, even after adjusting for covariates and possibly contaminating behaviors.
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