Differentiating depressed adolescent 24 h cortisol secretion in light of their adult clinical outcome

[Insomniac symptoms and suicidality-link and management]

BACKGROUND

A link between insomniac symptoms and suicidality has long been suspected and deserves specific attention.

OBJECTIVE

We examine the current evidence for this relationship from epidemiology and neurobiology in order to propose a targeted management.

MATERIAL AND METHOD

Clinical example and selective Medline-literature research for insomnia symptoms and suicidality.

RESULTS

Epidemiological data and statistical analysis show that symptoms of insomnia are independent risk factors for suicidality. Neurobiological factors associated with combined insomnia symptoms and suicidality are: serotonergic dysfunction and circadian rhythm disorder leading to hypofrontality with reduced problem solving capacity and impaired emotional and impulse-control. Social isolation, recurrent rumination, comorbid psychiatric disorders, access to potentially lethal drugs or weapons need urgent evaluation in patients with a combination of suicidality and symptoms of insomnia.

CONCLUSION

patients with insomnia and further risk factors for suicide need to be treated resolutely and at an early stage. Modern sleep-promoting antidepressants with low toxicity and antipsychotics must be preferred in the treatment of patients with insomniac sleep disorders and suicidality. Multimodal anti-insomnia and anti-depressive therapy adapted to the circadian rhythm can exert a favorable influence both on depressive-suicidal and insomnia symptoms and their inherent risks.

A Comprehensive Review of the Literature on Sleep Difficulties and Suicidality in Youth to Inform an Integrative Developmental Model and Future Directions

Purpose of Review

Suicide is currently the second leading cause of death among youth. Identification of modifiable near-term risk factors can inform suicide prevention strategies. One promising, readily assessed factor is sleep. We critically review the literature on sleep and suicidal thoughts and behaviors among youth.

Recent Findings

Most studies examining the youth sleep-suicidality relationship are from epidemiological samples in which both sleep problems and suicidality were assessed over variable timeframes using limited items from scales not designed to measure these constructs. Nonetheless, these data overwhelmingly support an association between suicidality and a range of sleep difficulties (e.g., insomnia, short/long sleep, weekend oversleep), above and beyond depressive symptoms. Limited studies include clinical samples or prospective designs. We review potential mechanisms and present a developmentally-informed integrative model.

Summary

Literature supports a clear association between sleep difficulties and youth suicidality. Future directions include prospective longitudinal studies and targeted prevention efforts.

Community-based participatory research: Suicide prevention for youth at highest risk in Guyana

Studied mostly in developed countries, the increased prevalence of suicide among youth, worldwide, is a preventable public health concern. Guyana, a developing country in South America, has the highest rate of youth death by suicide. Based on the diathesis-stress model, this community-based study aimed to identify both psychiatric and biological factors associated with repeated suicide attempts among high-risk youth.

OBJECTIVE

We measured psychiatric symptoms, childhood traumas, and cortisol to identify correlates with recurrent suicide attempts.

METHOD

Poisson regression tested the association between psychiatric symptoms, trauma, and cortisol levels on number of suicide attempts among 50 youths from three child welfare orphanages in Guyana. Sixty-six percent were female, and the average age was 14 years. DSM-5 symptom measure was administered and saliva samples collected.

RESULTS

Fifty percent of the youth endorsed suicide attempt. Within this subsample, a minimum of one and maximum of five suicide attempts were self-reported. Participants' number of suicide attempts was positively associated with number of past traumas, psychosis, and depression symptoms.

CONCLUSION

Suicide prevention screening among at-risk youth should target severity of psychosis and depression reports and number of traumatic life experiences.

Adolescent girls' stress responses as prospective predictors of self-injurious thoughts and behaviors: A person-centered, multilevel study

Adolescent risk for self-injurious thoughts and behaviors (STBs) involves disturbance across multiple systems (e.g., affective valence, arousal regulatory, cognitive and social processes). However, research integrating information across these systems is lacking. Utilizing a multiple-levels-of-analysis approach, this person-centered study identified psychobiological stress response profiles and linked them to cognitive processes, interpersonal behaviors, and STBs. At baseline, adolescent girls (N = 241, Mage = 14.68 years, Range = 12-17) at risk for STBs completed the Trier Social Stress Test (TSST), questionnaires, and STB interviews. Positive affect (PA), negative affect (NA), and salivary cortisol (SC) were assessed before and after the TSST. STBs were assessed again during 3, 6, and 9 month follow-up interviews. Multitrajectory modeling of girls' PA, NA, and SC revealed four profiles, which were compared on cognitive and behavioral correlates as well as STB outcomes. Relative to normative, girls in the affective distress, hyperresponsive, and hyporesponsive subgroups were more likely to report negative cognitive style (all three groups) and excessive reassurance seeking (hyporesponsive only) at baseline, as well as nonsuicidal self-injury (all three groups) and suicidal ideation and attempt (hyporesponsive only) at follow-up. Girls' close friendship characteristics moderated several profile-STB links. A synthesis of the findings is presented alongside implications for person-centered tailoring of intervention efforts.

Associations between the Type of Tobacco Products and Suicidal Behaviors: A Nationwide Population-Based Study among Korean Adolescents

The relationships between multiple tobacco products, such as heated tobacco products (HTPs), electronic cigarettes (ECs), and combustible cigarettes (CCs), and suicide-related behaviors among adolescents have not been extensively researched. This study examined the associations between the type of tobacco products used and suicidal thoughts, plans, and attempts among Korean adolescents. Data from the 2019 Korea Youth Risk Behavior Web-Based Survey were analyzed, and participants included 57,069 individuals aged 13–18 years. A multivariable logistic regression analysis was performed. Of the total participants, 13.0%, 4.0%, and 2.9% reported suicidal thoughts, suicidal plans, and suicidal attempts, respectively. After adjusting for confounding variables, all tobacco product users showed a greater likelihood of having suicidal behavior. However, compared with never users, dual users of CCs and HTPs were not significantly associated with having suicidal thoughts and attempts. Among tobacco product users, dual users of ECs and HTPs and triple users of CCs, ECs, and HTPs showed a greater likelihood of having suicidal behavior. Considering the prevalence of suicide and the increasing trend of using multiple tobacco products among Korean adolescents, tobacco control policies should monitor the effects of different products.

Suicidal ideation among nurses: Unique and cumulative effects of different subtypes of sleep problems

BACKGROUND

Nurses have high rates of sleep problems, and higher risk of suicide than the general population. However, there is no empirical evidence showing the extent to which sleep problems among nurses are related to suicidal ideation.

METHODS

Multistage stratified cluster sampling was performed to recruit nurses from tertiary hospitals in Shandong, China. Item 9 of the Patient Health Questionnaire-9 was used to assess suicidal ideation. The Pittsburgh Sleep Quality Index was used to assess different subtypes of sleep problems.

RESULTS

Overall prevalence of suicidal ideation among the sample was 10.8%. Nurses with sleep problems were at high risk for suicidal ideation (^bOR = 1.79, 95% CI = 1.20-2.65). Among different sleep problem subtypes, only "cannot breathe comfortably" was independently related to suicidal ideation. Different subtypes of sleep problems had cumulative effects on suicidal ideation: the more subtypes of sleep problems nurses experienced, the higher the likelihood of suicidal ideation.

LIMITATIONS

The cross-sectional study design prevents inferring causation, and the use of self-report measures may lead to recall bias. Other physical/mental conditions, besides depression, were not assessed. Statistical power may have been insufficient due to the small sub-sample who reported suicidal ideation. Also, the generalizability of the results is limited, as the sample only comprised nurses in tertiary hospitals.

CONCLUSIONS

Nurses experiencing sleep problems were associated with increased likelihood of suicidal ideation. It may be beneficial to incorporate sleep problems into routine screening and intervention for suicide prevention in clinical practice.

Premorbid sleep, appetite, energy, and cognitive circadian profile in patients with depressive disorders

Aim

Alterations of biological rhythms are well recognized to play a crucial role in the origin and maintenance of depression, but little is known about the profile of circadian rhythms at a premorbid age in adult depressed patients. The present study was aimed at investigating the association, if any, of depressive disorders with biological and behavioural rhythm modifications both at the time of observation and at an earlier age than the clinical onset of depression. The hypothesis was that such modifications could be an early biological index of vulnerability to the illness.

Subjects and methods

One hundred and seventy-eight patients affected by DSM-IV Major Depressive Disorder were examined/observed, compared to a group of 178 matched healthy subjects. All the included subjects were asked to fill in a retrospective questionnaire reporting time of awakening and falling asleep and time of subjective peaks of appetite, energy and cognitive function during “Adolescence” (12–15 years), “Youth” (16–20 years) and “Present condition” periods.

Results

An advance of awakening time by about 20 minutes during “Adolescence” was reported in the depressed subjects as compared to the controls. Awakening is also reported as significantly (P < 0.001) advanced by about 36 minutes during “Youth” in depressed patients, while time of falling asleep at the same age in the patients group shows 19 minutes delay. Regarding “Present condition” an advance of awakening time (33 minutes) in depressed patients was reported, in association with a delay of the subjective peak of cognitive functioning (62 minutes).

Discussion

Depressed patients show clear-cut differences in sleep pattern as compared to controls, consisting in a constant and significant advance of awakening time, while the time of sleep onset never reaches any statistical difference between the groups throughout ages.

Conclusions

The results are consistent with the hypothesis that early alterations of the general circadian profile can contribute to the onset of adult life Major Depressive Disorders.

Sleep problems and suicide risk in youth: A systematic review, developmental framework, and implications for hospital treatment

OBJECTIVE

Sleep problems are transdiagnostic symptoms that confer significant risk for suicidal thoughts and behaviors (STBs) in adults. However, less is known about the sleep-STB association in adolescence-a developmental period when rates of STBs increase drastically, and sleep problems may be particularly pernicious. This article provides a systematic review of research on the sleep-STB association in youth, an overview of changes in sleep regulation during adolescence that may make sleep problems particularly detrimental for youth, and a discussion of the clinical implications of the sleep-STB association for hospitalized youth.

METHOD

The systematic review included all longitudinal studies in which sleep problems were examined as prospective predictors of STBs in adolescents (aged 10-24 years). The search was conducted on December 1, 2017 using PsychINFO, PubMed, and Web of Science databases.

RESULTS

Ten studies qualified for inclusion in this review. Of these, seven studies found at least one type of sleep problem significantly predicted a STB outcome.

CONCLUSIONS

Although findings are mixed, growing research suggests that sleep problems may be a unique risk factor for STBs in youth. Sleep problems may be particularly important intervention target because they are easily assessed across healthcare settings and are amenable to treatment.

Cognitive and attentional vulnerability to depression in youth: A review

Although depressive disorders are among the most common disorders in youth, highly efficacious treatments for childhood affective disorders are lacking. There is significant need to better understand the factors that contribute to the development and maintenance of depression in youth so that treatments can be targeted at optimal mechanisms. The aim of the current paper was to synthesize research on cognitive and neurobiological factors associated with youth depression, guided by De Raedt and Koster's model (2010) for vulnerability to depression in adults. Consistent with model predictions, there is evidence that attentional impairments are greatest in the context of negative information, relative to positive or neutral information, and some evidence that attentional deficits are associated with rumination in depressed youth. However, we found little evidence for the model's assumption that attentional bias is an etiological and maintenance factor for depression. There are several other model predictions that require additional study as current data are lacking. Overall, De Raedt and Koster's (2010) integrative cognitive and biological framework has tremendous potential to move the field forward in understanding the development of depression in youth. Additional longitudinal studies incorporating measures across biological and cognitive levels of analysis are needed.

Sleep architecture in adolescents hospitalized during a suicidal crisis

OBJECTIVE/BACKGROUND

Rates of suicide attempts in Canadian youths are concerning. Adolescence is a sensitive period for the emergence of both sleep and mood problems, two major risk factors for suicidality. This naturalistic study aimed to define the sleep profile of adolescents under the combined influence of suicidality, depression and pharmacotherapy during hospitalization for a suicidal crisis.

PATIENTS/METHODS

Seventeen suicidal adolescents (15.0 + 1.2years, 82% females) with major depression were recruited from a Canadian pedopsychiatric inpatient unit. Seventeen non-depressed adolescents were retrospectively collated from another database (15.0 + 1.1years, 83% females). None of the participants had a history of sleep disorders or significant medical conditions.

RESULTS

Compared to controls, suicidal adolescents had a longer sleep onset latency (Z = -4.5, p < 0.001), longer REM latency (Z = -3.2, p = 0.001), higher percentage of NREM1 sleep t(33) = -2.6, p = 0.020), and higher REM density (Z = -2.8, p = 0.004) than controls. Higher REM density correlated with higher CDI-II scores (r = 0.55, p = 0.27) A significant interaction indicated that the two groups had similar NREM3 percentages in the first two-thirds of the night, but that the suicidal group had significantly lower NREM3 percentage than the controls in the last third of the night (F(2,66) = 3.4, p = 0.041).

CONCLUSIONS

Significant sleep abnormalities were observed during hospitalization for a suicidal crisis in a sample of depressed and mostly medicated adolescents. This included sleep initiation and REM sleep latency abnormalities, shallower sleep and high REM density. Future studies should decipher the relative effects of depression, suicidality and medication on sleep. These findings stress the need to address sleep disturbances in the management of suicidality in adolescents.

Annual Research Review: Suicide among youth - epidemiology, (potential) etiology, and treatment

BACKGROUND

Suicide is a leading cause of death and a complex clinical outcome. Here, we summarize the current state of research pertaining to suicidal thoughts and behaviors in youth. We review their definitions/measurement and phenomenology, epidemiology, potential etiological mechanisms, and psychological treatment and prevention efforts.

RESULTS

We identify key patterns and gaps in knowledge that should guide future work. Regarding epidemiology, the prevalence of suicidal thoughts and behaviors among youth varies across countries and sociodemographic populations. Despite this, studies are rarely conducted cross-nationally and do not uniformly account for high-risk populations. Regarding etiology, the majority of risk factors have been identified within the realm of environmental and psychological factors (notably negative affect-related processes), and most frequently using self-report measures. Little research has spanned across additional units of analyses including behavior, physiology, molecules, cells, and genes. Finally, there has been growing evidence in support of select psychotherapeutic treatment and prevention strategies, and preliminary evidence for technology-based interventions.

CONCLUSIONS

There is much work to be done to better understand suicidal thoughts and behaviors among youth. We strongly encourage future research to: (1) continue improving the conceptualization and operationalization of suicidal thoughts and behaviors; (2) improve etiological understanding by focusing on individual (preferably malleable) mechanisms; (3) improve etiological understanding also by integrating findings across multiple units of analyses and developing short-term prediction models; (4) demonstrate greater developmental sensitivity overall; and (5) account for diverse high-risk populations via sampling and reporting of sample characteristics. These serve as initial steps to improve the scientific approach, knowledge base, and ultimately prevention of suicidal thoughts and behaviors among youth.

Hyperarousal during sleep in untreated, major depressed subjects with prodromal insomnia: A polysomnographic study

In primary insomnia, specific dynamics of hyperarousal are evident during the night. Similarly, in major depression, many elements also favor of the presence of hyperarousal. Thus, it would be interesting to investigate if hyperarousal presents the same dynamic in major depression. Polysomnographic data from 30 healthy controls, 66 patients with major depression and prodromal insomnia, and 86 primary insomnia sufferers recruited from the sleep laboratory database were studied for whole night and thirds of the night. Insomnia sufferers and patients with depression exhibit a similar polysomnographic pattern both for whole night (increased sleep latency and WASO and reduced SWS and REM) and thirds of night (increased WASO at first and last thirds, reduced SWS in first third, and reduced in REM in first and last third). No alterations were detected during the second third of the night. Just as in primary insomnia, the hyperarousal phenomenon is found mainly in major depression with prodromal insomnia during the sleep-onset period and the first and last thirds of the night, but lesser during the second third of the night. These specific dynamics of hyperarousal may aid in the understanding of the particular relationship between insomnia and depression.

The Relationship of Disordered Eating Attitudes with Stress Level, Bone Turnover Markers, and Bone Mineral Density in Obese Adolescents

OBJECTIVE

To investigate the effect of stress caused by disordered eating attitudes on bone health in obese adolescents.

METHODS

A cross-sectional study comprising 80 obese adolescents was performed from November 2013 to September 2014. Twenty-four-hour urinary free cortisol levels were measured as a biological marker of stress. Bone turnover was evaluated using bone-specific alkaline phosphatase, serum osteocalcin, and urinary N-telopeptide concentrations. Bone mineral density was measured using dual-energy X-ray absorptiometry. The Eating Disorder Examination Questionnaire, Dutch Eating Behavior Questionnaire, Children's Depression Inventory, and the State-Trait Anxiety Inventory for Children were used to assess eating disorders, depression, and anxiety. Psychiatric examinations were performed for binge eating disorders.

RESULTS

In the Pearson's correlation test, a positive correlation was found between the 24-hour urinary cortisol level and Dutch Eating Behavior Questionnaire total and restrained eating subscale scores (p<0.05 for both). In linear regression analyses, the Dutch Eating Behavior Questionnaire total and restrained eating subscale scores were found to be significant contributors for urinary cortisol level (β=1.008, p=0.035; β=2.296, p=0.014, respectively). The femoral neck areal bone mineral density was found to be significantly higher in subjects who had binge eating disorder compared with those without binge eating disorder (p=0.049).

CONCLUSION

Despite the lack of apparent effects on bone turnover and bone mineral density in our obese adolescents at the time of the study, our results suggest that disordered eating attitudes, and especially restrained eating attitudes, might be a source of stress. Therefore, studies in this area should continue.

HPA Axis Interactions with Behavioral Systems

Perhaps the most salient behaviors that individuals engage in involve the avoidance of aversive experiences and the pursuit of pleasurable experiences. Engagement in these behaviors is regulated to a significant extent by an individual's hormonal milieu. For example, glucocorticoid hormones are produced by the hypothalamic-pituitary-adrenocortical (HPA) axis, and influence most aspects of behavior. In turn, many behaviors can influence HPA axis activity. These bidirectional interactions not only coordinate an individual's physiological and behavioral states to each other, but can also tune them to environmental conditions thereby optimizing survival. The present review details the influence of the HPA axis on many types of behavior, including appetitively-motivated behaviors (e.g., food intake and drug use), aversively-motivated behaviors (e.g., anxiety-related and depressive-like) and cognitive behaviors (e.g., learning and memory). Conversely, the manuscript also describes how engaging in various behaviors influences HPA axis activity. Our current understanding of the neuronal and/or hormonal mechanisms that underlie these interactions is also summarized. © 2016 American Physiological Society. Compr Physiol 6:1897-1934, 2016.

The underlying neurobiology of key functional domains in young people with mood and anxiety disorders: a systematic review

BACKGROUND

Mood and anxiety disorders are leading causes of disability and mortality, due largely to their onset during adolescence and young adulthood and broader impact on functioning. Key factors that are associated with disability and these disorders in young people are social and economic participation (e.g. education, employment), physical health, suicide and self-harm behaviours, and alcohol and substance use. A better understanding of the objective markers (i.e. neurobiological parameters) associated with these factors is important for the development of effective early interventions that reduce the impact of disability and illness persistence.

METHODS

We systematically reviewed the literature for neurobiological parameters (i.e. neuropsychology, neuroimaging, sleep-wake and circadian biology, neurophysiology and metabolic measures) associated with functional domains in young people (12 to 30 years) with mood and/or anxiety disorders.

RESULTS

Of the one hundred and thirty-four studies selected, 7.6 % investigated social and economic participation, 2.1 % physical health, 15.3 % suicide and self-harm behaviours, 6.9 % alcohol and substance use, whereas the majority (68.1 %) focussed on clinical syndrome.

CONCLUSIONS

Despite the predominance of studies that solely examine the clinical syndrome of young people the literature also provides evidence of distinct associations among objective measures (indexing various aspects of brain circuitry) and other functional domains. We suggest that a shift in focus towards characterising the mechanisms that underlie and/or mediate multiple functional domains will optimise personalised interventions and improve illness trajectories.

Multi-Level Risk Factors for Suicidal Ideation Among at-Risk Adolescent Females: The Role of Hypothalamic-Pituitary-Adrenal Axis Responses to Stress

Adopting a multi-level approach, this study examined risk factors for adolescent suicidal ideation, with specific attention to (a) hypothalamic-pituitary-adrenal (HPA) axis stress responses and (b) the interplay between HPA-axis and other risk factors from multiple domains (i.e., psychological, interpersonal and biological). Participants were 138 adolescent females (M(age) = 14.13 years, SD = 1.40) at risk for suicidal behaviors. At baseline, lifetime suicidal ideation and a number of risk factors were assessed (i.e., depressive symptoms, impulsiveness, pubertal status and peer stress). Participants were exposed to a psychosocial stress task and HPA-axis responses were assessed by measuring cortisol levels pre- and post-stressor. At 3 months post-baseline, suicidal ideation again was assessed. Using group-based trajectory modeling, three groups of cortisol stress-response patterns were identified (i.e., hyporesponsive, normative, and hyperresponsive). As compared to females in the normative and hyporesponsive group, females in the hyperresponsive group were more likely to report a lifetime history of suicidal ideation at baseline, above and beyond the effects of the other predictors. Moreover, as compared to females in the normative group, females in the hyperresponsive group were at increased risk for reporting suicidal ideation 3 months later, after controlling for prior ideation. No interactions between cortisol group and the other risk factors were significant, with the exception of a non-significant trend between impulsiveness and cortisol group on lifetime suicidal ideation. Findings highlight the importance of HPA-axis responses to acute stressors as a risk factor for suicidal ideation among adolescents.

Increased risk of suicide attempt in bipolar patients with severe tobacco dependence

BACKGROUND

The aim of our study was to investigate, in bipolar patients, the association between tobacco status (use and dependence) and history of suicide attempt, and to assess the possible role of inflammation as a missing link in the association between smoking status and history of suicide attempt.

METHODS

A total of 453 adult bipolar out-patients recruited in the French FondaMental Advanced Centres of Expertise for Bipolar Disorder were divided into two subgroups: 274 patients without past history of suicide attempt (non-SA), and 179 patients with a past history of suicide attempt (SA). Tobacco use and dependence, psychiatric and somatic comorbidities, history of childhood abuse, family history of suicide were assessed. Fasting blood tests yielded samples collected for the measurement of high sensitivity (hs-)CRP.

RESULTS

The risk of suicide attempt increased with smoking dependence. Notably, bipolar patients with a history of suicide attempt were three times more likely to have severe tobacco dependence, independently of confounding factors. However, we failed to find arguments promoting the hypothesis of inflammatory markers (through hs-CRP measure) in the link between tobacco dependence and suicidal behavior.

CONCLUSIONS

We found a significant association between severe tobacco dependence and history of suicide attempt, but not with level of CRP, independently of confusing factors. Longitudinal studies taken into account all these potential confusing factors are needed to confirm our results.

Sleep in adolescent depression: physiological perspectives

Depression and disturbed sleep are intimately and bidirectionally related. During adolescence, the incidence of both insomnia and major depression increases simultaneously, in a gender-specific manner. The majority of depressed adolescents suffer from different types of subjective sleep complaints. Despite these complaints, the results from polysomnographic studies in depressed adolescents remain inconsistent. In general, similar features to those seen among adults with depressive disorder (e.g. abnormalities in rapid eye movement sleep and difficulties in sleep onset) have been reported, but expressed to a lesser degree. The inconsistency in findings may be linked with maturational factors, factors related to the stage of illness and greater heterogeneity in the clinical spectrum of depression among adolescents. The exact neurobiological mechanisms by which sleep alterations and depression are linked during adolescence are not fully understood. Aberrations in brain maturation, expressed at different levels of organization, for example gene expression, neurotransmitter and hormone metabolism, and activity of neuronal networks have been suggested. The circadian systems may change in adolescent depression beyond that observed during healthy adolescent development (i.e. beyond the typical circadian shift towards eveningness). A number of therapeutic approaches to alleviate sleep disruption associated with depression have been proposed, but research on the efficacy of these interventions in adolescents is lacking. Knowledge of the neurobiological links between sleep and depression during adolescence could lead to new insights into effective prevention and treatment of depression.

Avaliação do funcionamento do eixo HPA em deprimidos por meio de medidas basais: revisão sistemática da literatura e análise das metodologias utilizadas

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.

Depressed suicidal adolescent males have an altered cortisol response to a pharmacological challenge

Dysregulation of the HPA axis and the dysfunction of the central serotonin (5HT) system are the most replicated biomarkers of depression and suicidal ideation and behavior. However, few studies have examined the two systems simultaneously. In this study, cortisol response was measured in depressed adolescents, following the administration of a central serotonin receptor agonist, meta-chlorphenylpiprazine (mCPP). Adolescents with major depression (MDD; n = 44; males = 15, females = 29; mean age ± SD = 15.5 ± 1.5) were divided into two groups: non-suicidal or those who reported passive suicidal ideation (n = 21), and those who had either threatened suicide or engaged in suicidal acts (n = 23). Sequential infusions of normal saline and mCPP were administered, and serial blood samples were collected for cortisol response. A differential time by group pattern of cortisol response following mCPP was found in the entire group (F(6,242) = 2.6, p=0.018). However, this was mostly attributed to males (F(6,73) = 2.3, p = 0.043) who had threatened or engaged in suicidal acts and displayed a higher cortisol response at 10 and 25 min after the infusion of mCPP, which was not affected by the severity of depression. This differential pattern of cortisol secretion in response to a serotonergic agonist may be a biomarker for more severe forms of suicidal ideation and behavior in adolescent males.

Biological indicators of suicide risk in youth with mood disorders: what do we know so far?

Suicidal behaviour in youth is a major public health concern worldwide, and youth in the early stages of a primary mood disorder are an identifiable high-risk population. Neurobiological research in youth at risk for suicidality has sought to investigate the most promising parameters from research in adults. The present paper provides an overview of the current findings of neurobiological research in children and adolescents with mood disorders and suicidality including genetic/epigenetic findings, neuro-hormonal and immunological investigations. Longitudinal research in high-risk youth is a powerful way to investigate the influences and their pathways in determining suicidal risk in the context of a developing mood disorder. In the meantime, there are clear clinical indicators of risk to help identify youth who would benefit from close surveillance and early intervention.

Cigarette smoking and risk of completed suicide: a meta-analysis of prospective cohort studies

BACKGROUND

Epidemiologic studies have reported conflicting results relating smoking to suicide risk. We conducted a meta-analysis of prospective cohort studies to evaluate the association of cigarette smoking with completed suicide.

METHODS

Eligible prospective cohort studies were identified from PubMed and EMbase databases (from 1966 to May 2011) and the reference lists of retrieved articles. Two authors independently extracted data and assessed study quality using the Newcastle-Ottawa Scale. Study-specific risk estimates were pooled using random-effects model and generalized least squares trend estimation was used to assess dose-response relationship.

RESULTS

Fifteen prospective cohort studies involving 2395 cases among 1,369,807 participants were included in the meta-analysis. Our data suggested that cigarette smoking significantly increased the risk of completed suicide. Compared with never smokers, the pooled RR was 1.28 (95% CI: 1.001-1.641) for former smokers, and 1.81 (95% CI: 1.50-2.19) for current smokers, respectively. Subgroup analyses showed that the increased suicide risk among current smokers appeared to be consistent, although there was heterogeneity among studies of current smoking (p < 0.001). Significant dose-response relationship was found between smoking and suicide, and the risk of suicide was increased by 24% for each increment of 10 cigarettes smoked per day (RR, 1.24; 95% CI: 1.20-1.28).

CONCLUSIONS

Our meta-analysis robustly demonstrates that cigarette smoking is associated with an increased risk of completed suicide, consistent with a dose-response relationship. This conclusion has an important public health message for countries with high smoking prevalence and high suicide rate such as China.

Psychobiological responses to unpleasant emotions in cannabis users

Aim of this paper is to investigate the psychobiological reactions to experimentally induced negative emotional states in active marijuana-dependent smokers and whether changes in emotional reactivity were reversed by prolonged abstinence. Twenty-eight patients were randomly included into group A (fourteen active marijuana-dependent smokers) or group B (fourteen abstinent marijuana-dependent subjects). Emotional response evaluation of group B subjects was assessed after 6 months of abstinence. Fourteen healthy volunteers, matched for age and sex, were used as controls. Psychometric and emotional response evaluations were performed by administering Symptoms Check List-90 and State-Trait Anxiety Inventory Y-1 (STAI). Neutral and unpleasant set of pictures selected from the international affective picture system and the Self-Assesment Manikin procedure (SAM) have been used to determine ratings of pleasure and arousal. Before and after the experimental session, blood samples were collected to determine ACTH and cortisol plasma levels. Active cannabis users displayed significantly higher levels of pleasantness SAM scores and lower levels of arousal SAM scores compared to abstinent cannabis users and controls in response to emotional task. In a close parallel with psychological data, hormonal findings indicate a persistent hyperactivity of hypothalamus-pituitary-adrenal (HPA) axis in cannabis users, particularly among active marijuana smokers, and an impaired hormonal reaction to negative emotions, in comparison with healthy subjects. The capacity of the HPA axis to respond to stressful stimuli/negative emotions seems to be only partially recovered after 6 months of abstinence. Ours findings, although obtained in a small number of subjects, suggest an association between active cannabis use, subjective reduced sensitivity to negative emotions and threat and HPA axis dysfunction.

In search of HPA axis dysregulation in child and adolescent depression

Dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis in adults with major depressive disorder is among the most consistent and robust biological findings in psychiatry. Given the importance of the adolescent transition to the development and recurrence of depressive phenomena over the lifespan, it is important to have an integrative perspective on research investigating the various components of HPA axis functioning among depressed young people. The present narrative review synthesizes evidence from the following five categories of studies conducted with children and adolescents: (1) those examining the HPA system’s response to the dexamethasone suppression test (DST); (2) those assessing basal HPA axis functioning; (3) those administering corticotropin-releasing hormone (CRH) challenge; (4) those incorporating psychological probes of the HPA axis; and (5) those examining HPA axis functioning in children of depressed mothers. Evidence is generally consistent with models of developmental psychopathology that hypothesize that atypical HPA axis functioning precedes the emergence of clinical levels of depression and that the HPA axis becomes increasingly dysregulated from child to adult manifestations of depression. Multidisciplinary approaches and longitudinal research designs that extend across development are needed to more clearly and usefully elucidate the role of the HPA axis in depression.

Associations between DSM-IV diagnosis, psychiatric symptoms and morning cortisol levels in a community sample of adolescents

PURPOSE

Dysfunction of the hypothalamic-pituitary-adrenocortical axis (HPA-axis) is implicated in a variety of psychiatric and emotional disorders. In this study, we explore the association between HPA-axis functioning, as measured by morning cortisol, and common psychiatric disorders and symptoms among a community sample of adolescents.

METHOD

Data from a cross-sectional school-based survey of 501 school pupils, aged 15, were used to establish the strength of association between salivary morning cortisol and both diagnosis of psychiatric disorders and a number of psychiatric symptoms, as measured via a computerised psychiatric interview. Analysis, conducted separately by gender, used multiple regressions, adjusting for relevant confounders.

RESULTS

With one exception (a positive association between conduct disorder symptoms and cortisol among females) there was no association between morning cortisol and psychiatric diagnosis or symptoms. However, there was a significant two-way interaction between gender and conduct symptoms, with females showing a positive and males a negative association between cortisol and conduct symptoms. A further three-way interaction showed that while the association between cortisol and conduct symptoms was negative among males with a few mood disorder symptoms, among females with many mood symptoms it was positive.

CONCLUSIONS

Except in relation to conduct symptoms, dysregulation of morning cortisol levels seems unrelated to any psychiatric disorder or symptoms. However, the relationship between cortisol and conduct symptoms is moderated by both gender and mood symptoms. Findings are compatible with the recent work suggesting research should concentrate on the moderated associations between gender, internalising and externalising symptoms and cortisol, rather than any simple relationship.

Pediatric Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Research on pediatric Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is reviewed in this article. Many recent articles in this area highlight the existence of key differences between the adult and pediatric forms of the illness. This review article provides an overview of pediatric ME/CFS, including epidemiology, diagnostic criteria, treatment, and prognosis. Challenges to the field are identified with the hope that in the future pediatric cases of ME/CFS can be more accurately diagnosed and successfully managed.

Allostasis and the development of internalizing and externalizing problems: Changing relations with physiological systems across adolescence

Allostasis, or the maintenance of stability through physiological change, refers to the process by which individuals adjust to the continually changing demands that are put upon somatic activity by salient events. Bauer and colleagues proposed that allostasis could be detected through patterns of the joint reactivity of the autonomic nervous system (ANS) and hypothalamic–pituitary–adrenal (HPA) axis system under stressful conditions. We examined the associations between ANS and HPA reactivity and the development of externalizing and internalizing problems over 2 years in a sample of 215 adolescents. The interactions of ANS and HPA reactivity were contemporaneously associated with, and longitudinally predictive of, adolescents' emotional and behavioral problems. Adolescents with symmetrical high reactivity across systems had more internalizing and fewer externalizing problems initially. Over time, both symmetrical and asymmetrical reactivity predicted increasing internalizing problems in girls, depending on the measure of ANS activity that was examined, heart rate, or blood pressure reactivity. Implications for the understanding of allostasis and the dynamic nature of the relations between multiple physiological regulatory systems and adolescents' developing psychopathology are discussed.

Sleep disturbances and suicidality: a common association to look for in clinical practise and preventive care

Suicidality and suicide has been associated with many risk factors, while recent clinical and epidemiological studies increasingly point to a potential link between sleep loss or sleep disturbances and suicidality. This review on studies of sleep disturbances associated with suicidality, i.e., suicidal ideation, suicide attempt and completed suicide suggests a frequent association especially with insomnia and nightmares but also hypersomnia and sleep panic attacks. In suicidal insomniacs with comorbid psychiatric disorders, there is some evidence for an even independent predictive nature of sleep problems for suicidality. Considerations on the shared neurobiology, risk assessment and treatment options complement the overview. Thus, sleep disturbances may qualify as an individual treatable target of personalised medicine in the clinical routine as well as in suicide prevention programmes. A more detailed assessment of sleep problems and identification of specific risk domains in primary or secondary prevention of suicidality seem to be a future area of high importance.

Behavioral adjustment in a community sample of boys: links with basal and stress-induced salivary cortisol concentrations

Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis has been observed in association with internalizing symptoms and is thought to be involved in the pathogenesis of depression and some anxiety disorders. This study examined basal and stress-induced cortisol concentrations in relation to internalizing and externalizing symptoms in a racially mixed community sample of 102 8-11-year-old boys. Afternoon basal cortisol concentrations were positively correlated with measures of internalizing behavior problems, social problems, and emotionality. Greater change in cortisol across a home-visit challenge task was also significantly associated with internalizing behaviors and social problems, as well as attention and thought problems. The implications of these findings and how they may relate to the pathogenesis of emotional and behavioral problems are discussed.

Trauma, attempted suicide, and morning cortisol in a community sample of adolescents

Individuals exposed to trauma or who have attempted suicide may show abnormal cortisol profiles; those exposed to significant trauma show reduced, while those who attempt suicide show increased cortisol output, although the evidence is inconsistent. This study explores the associations between morning cortisol, trauma, and suicide attempts or ideation among young people. In a community-based sample of 501 15-year-olds, using data from a DSM-IV-compatible interview on suicidal-behavior/ideation, trauma, and morning cortisol, we found no association between these factors and morning cortisol. A significant gender interaction was found for those threatened with a weapon-men showing a negative and women a positive association, suggesting that any cortisol/trauma association may be partially explained by coexisting behavioral problems and gender.

Characteristics, correlates, and outcomes of childhood and adolescent depressive disorders

Depressive illness beginning early in life can have serious developmental and functional consequences. Therefore, understanding the disorder during this developmental stage is critical for determining its etiology and course, as well as for deveiopinq effective intervention straieqies. This paper summarizes current knoviedqe reqardinq the etiology, phenomenoiogy, correlates, natural course, and consequences of unipolar depression in children and adolescents. Using adult depression as a framevork, the unique aspects of childhood and adolescence are considered in order to better understand depression within a developmental context. The data suggest that the clinical presentation, correlates, and natural course of depression are remarkably similar across the lifespan. There are, however, important developmental differences. Specifically, the familial and psychological context in which depression develops in youngsters is associated with variability in the frequency and nature of depressive symptoms and comorbid conditions among children and adolescents. Maturational differences have also been identified in the neurobiological correlates of depression. These developmental differences may be associated with the observed variability in clinical response to treatment and longitudinal course. Characterization of the developmental differences will be helpful in developing more specific and effective interventions for youngsters, thereby allowing them to reach their full potential as adults.

HPA axis hyperactivity and attempted suicide in young adult mood disorder inpatients

BACKGROUND

Hyperactivity of the Hypothalamic-Pituitary-Adrenal (HPA) axis is a consistent finding in Major Depressive Disorder (MDD) and most prospective studies of HPA-axis function have found that non-suppressors in the dexamethasone suppression test (DST) are more likely to commit suicide during follow-up. The results of studies on HPA-axis function and attempted suicide are less consistent. Suicide attempts are more common among young people than the elderly, whereas suicide is more common among the elderly. The impact of age related changes in HPA-axis system activity in relation to suicidal behaviour across the lifecycle may be of importance.

METHODS

The aim of the present study was to investigate the DST results in 36 young adult (30 years or younger) inpatients with mood disorder, with (n=18) and without suicide attempt at the index episode.

RESULTS

The DST non-suppressor rate was 25% among young mood disorder inpatients. DST non-suppression was associated with suicide attempt and post-dexamethasone serum cortisol at 11:00 p.m. was significantly higher in suicide attempters compared to non-attempters. The DST non-suppressor rate was 39% in young adult suicide attempters compared with 11% in non-attempters.

CONCLUSIONS

The results add to previous evidence in support of the role of HPA axis hyperactivity and suicidal behaviour. The present findings motivate to include HPA axis measures in the assessment of depression in young adults.

Risk markers for depression in adolescents: sleep and HPA measures

Previous work has demonstrated reliable electroencephalographic (EEG) sleep and hypothalamic-pituitary-adrenal (HPA) changes associated with adult major depressive disorder. These changes might be evident before clinical manifestation of the illness in at-risk persons. The aim of the study was to identify depression-related EEG sleep and HPA changes in healthy adolescents at high risk for depression, and to examine the relationship between EEG sleep (or HPA) changes and the onset of depression. Forty-eight adolescent volunteers with no personal history of a psychiatric illness, including depression, but who were at high risk for developing depression by virtue of parental depression (high-risk group), and 48 adolescent volunteers with no personal or family history of a psychiatric disorder (normal controls) were recruited. EEG sleep and HPA measures were collected on three consecutive evenings and nights at baseline. Clinical follow-up evaluations were conducted at regular intervals over a 5-year period. Compared with normal controls, adolescents at high risk for depression had shorter latency to rapid eye movement (REM) sleep, increased phasic REM sleep, more REM sleep and elevated nocturnal urinary-free cortisol (NUFC) excretion at baseline. Shorter REM latency, higher REM density and elevated NUFC (measured at baseline) were associated with the development of depression during follow-up. The findings that REM sleep abnormalities and elevated HPA activity occur before the onset of depression in at-risk adolescents suggest that these variables serve as vulnerability markers for the illness.

Emotion (Dys)regulation and Links to Depressive Disorders

Clinical depression is a significant mental health problem that is associated with personal suffering and impaired functioning. These effects underscore the continuing need for new approaches that can inform researchers and clinicians when designing interventions. We propose that individual differences in the self-regulation of sadness and distress provide an important link between stress, depressed mood, and the onset of depressive disorder, and that if we have a better understanding of the ways children successfully manage negative emotions, we can better prevent and treat pediatric depression. In this article, we therefore examine the normative development of responses that children use to attenuate sadness, and aspects of the neurobiological infrastructure that both enable and constrain such self-regulatory efforts. We also address the emerging literature on affect regulation among children at familial risk for depressive disorders. We conclude that problems with adaptively self-regulating sadness and distress represent one pathway that can lead to juvenile-onset depression. And we need integrated, developmental studies of the psychosocial and neurobiological aspects of self-regulatory responses to sadness and distress in order to better understand this process, and to design age-sensitive intervention strategies for pediatric depression.

Stress, genes and the biology of suicidal behavior

Suicidal behavior is partly heritable. Studies seeking the responsible candidate genes have examined genes involved in neurotransmitter systems shown to have altered function in suicide and attempted suicide. These neurotransmitter systems include the serotonergic, noradrenergic, and dopaminergic systems and the hypothalamic-pituitary-adrenal axis. With some exceptions, most notably the serotonin transporter gene promoter polymorphism (HTTLPR), replication of candidate gene association studies findings has been difficult. This article reviews current knowledge of specific gene effects and gene-environment interactions that influence risk for suicidal behavior. Effects of childhood stress on development and how it influences adult responses to current stress are shown to be relevant for mood disorders, aggressive/impulsive traits, and suicidal behavior.

Social neuroscience of child and adolescent depression

The social neuroscience of child and adolescent depression is inherently multidisciplinary. Depressive disorders beginning early in life can have serious developmental and functional consequences. Psychopathology research has described depression's defining clinical and contextual features, and intervention research has characterized its response to treatment and prevention programs. Neuroendocrine, electrophysiological, and neuroimaging studies have identified core neurobiological aspects of early-onset mood disorders. These areas are reviewed using a developmental social neuroscience perspective for integrating disparate observations. The paper introduces a dynamic adaptive systems framework, and it discusses hedonic capacity, stress sensitivity, ruminative self-focus, and attentional impairments as fundamental components of mood disorders.

A review of prospective studies of biologic predictors of suicidal behavior in mood disorders

Predicting suicide is difficult due to the low base rate, even in high-risk groups, and the multi-causal nature of suicidal behavior. Clinical predictors have shown low specificity. Retrospective and cross-sectional studies have identified a number of biologic anomalies associated with suicide and suicide attempt. Prospective studies provide estimates of the predictive utility of biologic measures. Here we review prospective studies of suicidal behavior and serotonergic, noradrenergic, dopaminergic and hypothalamic-pituitary-adrenocortical axis function in mood disorders. The most promising biologic predictors are low CSF 5-HIAA and HPA axis dysfunction as demonstrated by dexamethasone non-suppression that are each associated with about 4.5 fold greater risk of suicide.

Sleep and youth suicidal behavior: a neglected field

PURPOSE OF REVIEW

Sleep undergoes substantial changes during adolescence and suicide risk begins to increase during this period as well. This review focuses on recent literature on the relationship between sleep and suicidal behavior and proposes directions for future research.

RECENT FINDINGS

Adolescent sleep is characterized by widespread sleep restriction, irregular sleep schedules, daytime sleepiness, and elevated risk for sleep disturbances. More research on adolescent sleep and psychosocial impairment, psychiatric disorders, and suicidal behavior has been conducted. Suicidal psychiatric patients had more sleep disturbances including insomnia, hypersomnia, or nightmares than nonsuicidal patients. Shorter rapid eye movement latency and increased rapid eye movement activity have been noted to be a marker of suicidality in psychiatric patients. Epidemiological studies have demonstrated that insomnia, nightmares, and sleep insufficiency are associated with elevated risk for suicide. Although the link between insomnia and suicidal behavior appears to be mediated by depression, existing data suggest an independent predictive role of nightmares in future suicidal behavior.

SUMMARY

Sleep loss or disturbances are likely to signal an increased risk of future suicidal action in adolescents. Large-scale prospective studies and neurobiological studies are needed for a better understanding of the complex relationship between sleep, psychopathology, and youth suicidal behavior.

Environmental Control, Social Context, and Individual Differences in Behavioral and Cortisol Responses to Novelty in Infant Rhesus Monkeys

The effects of appetitive controllability on behavioral and cortisol reactivity to novelty in 12 infant rhesus monkeys were studied. Surrogate-peer-reared infants had homecage access to food treats contingently via lever pressing ("master") or noncontingently ("yoked") for 12 weeks from postnatal month 2. Masters lever-pressed more, but did not differ in baseline cortisol. At month 5, infants were exposed to a novel environment in social groups and individually. Masters were significantly more active and exhibited significantly lower cortisol reactivity to the novel environment, but only in the individual context. Also, individual differences in operant behavior were positively correlated with behavioral activity and negatively correlated with cortisol reactivity to the novel environment. The results reveal context-specific benefits of contingent stimulation in infancy.

Metabolic depression in hibernation and major depression: an explanatory theory and an animal model of depression

Metabolic depression, an adaptive biological process for energy preservation, is responsible for torpor, hibernation and estivation. We propose that a form of metabolic depression, and not mitochondrial dysfunction, is the process underlying the observed hypometabolism, state-dependent neurobiological changes and vegetative symptoms of major depression in humans. The process of metabolic depression is reactivated via differential gene expression in response to perceived adverse stimuli in predisposed persons. Behavior inhibition by temperament, anxiety disorders, genetic vulnerabilities, and early traumatic experiences predispose persons to depression. The proposed theory is supported by similarities in the presentation and neurobiology of hibernation in bears and major depression and explains the yet unexplained neurobiological changes of depression. Although, gene expression is suppressed in other hibernators by deep hypothermia, bears were chosen because they hibernate with mild hypothermia. Pre-hibernation in bears and major depression with atypical features are both characterized by fat storage through overeating, oversleeping, and decreased mobility. Hibernation in bears and major depression with melancholic features are characterized by withdrawal from the environment, lack of energy, loss of weight from not eating and burning stored fat, changes in sleep pattern, and the following similar neurobiological findings: reversible subclinical hypothyroidism; increased concentration of serum cortisol; acute phase protein response; low respiratory quotient; oxidative stress response; decreased neurotransmitter levels; and changes in cyclic-adenosine monophosphate-binding activity. Signaling systems associated with protein phosphorylation, transcription factors, and gene expression are responsible for the metabolic depression process during pre-hibernation and hibernation. Antidepressants and mood stabilizers interfere with the hibernation process and produce their therapeutic effects by normalizing the fluctuation of activities in the different signaling systems, which are down-regulated during hibernation and depression and up-regulated during exodus from hibernation and the hypomanic or manic phase of mood disorders. The ways individuals cognitively perceive, understand, communicate, and react to the vegetative symptoms of depression, from downregulation in energy production, and in the absence of known medical causes, produce the other characteristics of depression including guilt, helplessness, hopelessness, suicidal phenomena, agitation, panic attacks, psychotic symptoms, and sudden switch to hypomanic or manic episodes. The presence of one or more of these characteristics depends on the person's neuropsychological function, its social status between the others, and the other's response to the person. Neurobiological changes associated with metabolic depression during entrance, maintenance, and exodus from hibernation in bears is suggested as a natural animal model of human depression and mood disorders.

Altering the course of neurodevelopment: a framework for understanding the enduring effects of psychotropic drugs

Childhood is a time filled with wondrous changes, as brain plasticity permits experiences to shape the immature brain to meet the demands of the environment. Change occurs at various levels--from neuroanatomy, including within a given region and its connectivity to other regions, to the function of neurotransmitter systems and their reactivity to pharmacological agents in the short- and long-term. The nature and degree to which drug exposure influences the final adult topography is influenced greatly by the maturational phase of these critical factors. Moreover, evidence is slowly emerging that suggests that the long-term effects of drug exposure are delayed and expressed once the vulnerable system reaches maturation (i.e., typically during adulthood). This phenomenon is known as neuronal imprinting and occurs when the effects of drug exposure outlast the drug itself. Thus, understanding the persistent effects critically depends on the window of observation. Embracing this concept should influence how we conduct preclinical assessments of developmental drug exposure, and ultimately how we conduct clinical assessments of drug efficacy, effectiveness, and safety for the treatment of childhood psychiatric disorders. In this article, we present a model to provide a heuristic framework for making predictions about imprinted effects of childhood drug exposure. We then review epidemiological data on attention deficit hyperactivity disorder (ADHD) and childhood depression, prescription practices, and what is known regarding the long-term consequences of drug exposure in these populations. We conclude with a discussion of the current status of preclinical studies on juvenile stimulant exposure.

Twenty-four-hour cortisol secretion patterns in prepubertal children with anxiety or depressive disorders

BACKGROUND

Previous studies found few abnormalities in hypothalamic-pituitary-adrenal (HPA) axis function in prepubertal children with anxiety or depressive disorders. In this study, we combined data from two independent, consecutive studies to achieve a larger sample size. Our goal was to identify potential alterations in the circadian pattern of cortisol secretion in anxious or depressed children.

METHODS

A total of 124 prepubertal subjects from two independent samples (76 with major depressive disorder, 31 with anxiety disorders, and 17 healthy control subjects) were studied. Blood samples collected for cortisol at hourly intervals over a 24-hour period were examined. Analyses were performed aligning cortisol samples by clock-time. Additional analyses aligning samples by sleep-onset time were performed with a subsample of subjects.

RESULTS

In the combined sample, significant findings emerged that were previously undetected. Anxious children exhibited significantly lower nighttime cortisol levels and an initially sluggish rise in cortisol during the nighttime when compared with depressed and healthy control children. In contrast, depressed children did not show a clear-cut pattern of differences compared with healthy control children.

CONCLUSIONS

Anxious children seem to exhibit an altered pattern of nighttime cortisol secretion, with an initially sluggish or delayed nocturnal rise before reaching similar peak levels of cortisol near the time of awakening. These findings suggest subtle alterations in HPA axis function in prepubertal children with anxiety disorders.