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Salivary cortisol levels and the 2-year course of depressive and anxiety disorders.
Psychoneuroendocrinology. 2013 Sep; 38(9):1494-502.P

Abstract

INTRODUCTION

Depression and anxiety disorders have been associated with hyperactivity of the hypothalamic-pituitary adrenal (HPA) axis. However, lower cortisol levels have also been observed in depressed patients. Whether cortisol level predicts the course of these disorders has not been examined in detail. We examined whether salivary cortisol indicators predict the 2-year course of depression and anxiety disorders.

METHODS

Longitudinal data are obtained from 837 participants of the Netherlands Study of Depression and Anxiety, with a DSM-IV based depressive and/or anxiety disorder at baseline. At baseline, seven saliva samples were obtained, including the 1-h cortisol awakening response, evening cortisol level and a 0.5mg dexamethasone suppression test. At follow-up, DSM-IV based diagnostic interviews and Life Chart Interview integrating diagnostic and symptom trajectories over 2 years were administered to determine an unfavorable course.

RESULTS

41.5% of the respondents had a 2-year unfavorable course trajectory without remission longer than 3 months. Adjusted analyses showed that a lower awakening response was associated with an unfavorable course (RR=0.83, p=0.03). No associations were found between evening cortisol or cortisol suppression after dexamethasone ingestion and an unfavorable course trajectory.

CONCLUSIONS

Among patients with depressive or anxiety disorders, a lower cortisol awakening response - which may be indicative of underlying exhaustion of the HPA axis - predicted an unfavorable course trajectory.

Links

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Authors+Show Affiliations

Vreeburg SA
Department of Psychiatry, EMGO institute for Health and Care research, VU University Medical Center, Amsterdam, The Netherlands.
Hoogendijk WJ
No affiliation info available
DeRijk RH
No affiliation info available
van Dyck R
No affiliation info available
Smit JH
No affiliation info available
Zitman FG
No affiliation info available
Penninx BW
No affiliation info available

MeSH

AdolescentAdrenal CortexAdultAgedAnxiety DisordersArea Under CurveCardiovascular DiseasesCircadian RhythmComorbidityDepressive DisorderDexamethasoneDisease ProgressionFemaleFollow-Up StudiesHumansHydrocortisoneHypothalamo-Hypophyseal SystemInterview, PsychologicalMaleMiddle AgedNetherlandsPituitary-Adrenal SystemSalivaSecretory RateSmokingSocioeconomic FactorsYoung Adult

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23313277

Citation

Vreeburg, Sophie A., et al. "Salivary Cortisol Levels and the 2-year Course of Depressive and Anxiety Disorders." Psychoneuroendocrinology, vol. 38, no. 9, 2013, pp. 1494-502.
Vreeburg SA, Hoogendijk WJ, DeRijk RH, et al. Salivary cortisol levels and the 2-year course of depressive and anxiety disorders. Psychoneuroendocrinology. 2013;38(9):1494-502.
Vreeburg, S. A., Hoogendijk, W. J., DeRijk, R. H., van Dyck, R., Smit, J. H., Zitman, F. G., & Penninx, B. W. (2013). Salivary cortisol levels and the 2-year course of depressive and anxiety disorders. Psychoneuroendocrinology, 38(9), 1494-502. https://doi.org/10.1016/j.psyneuen.2012.12.017
Vreeburg SA, et al. Salivary Cortisol Levels and the 2-year Course of Depressive and Anxiety Disorders. Psychoneuroendocrinology. 2013;38(9):1494-502. PubMed PMID: 23313277.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Salivary cortisol levels and the 2-year course of depressive and anxiety disorders. AU - Vreeburg,Sophie A, AU - Hoogendijk,Witte J G, AU - DeRijk,Roel H, AU - van Dyck,Richard, AU - Smit,Johannes H, AU - Zitman,Frans G, AU - Penninx,Brenda W J H, Y1 - 2013/01/11/ PY - 2012/06/01/received PY - 2012/12/14/revised PY - 2012/12/19/accepted PY - 2013/1/15/entrez PY - 2013/1/15/pubmed PY - 2014/5/16/medline KW - Anxiety disorder KW - Course KW - Depressive disorder KW - HPA axis KW - Salivary cortisol SP - 1494 EP - 502 JF - Psychoneuroendocrinology JO - Psychoneuroendocrinology VL - 38 IS - 9 N2 - INTRODUCTION: Depression and anxiety disorders have been associated with hyperactivity of the hypothalamic-pituitary adrenal (HPA) axis. However, lower cortisol levels have also been observed in depressed patients. Whether cortisol level predicts the course of these disorders has not been examined in detail. We examined whether salivary cortisol indicators predict the 2-year course of depression and anxiety disorders. METHODS: Longitudinal data are obtained from 837 participants of the Netherlands Study of Depression and Anxiety, with a DSM-IV based depressive and/or anxiety disorder at baseline. At baseline, seven saliva samples were obtained, including the 1-h cortisol awakening response, evening cortisol level and a 0.5mg dexamethasone suppression test. At follow-up, DSM-IV based diagnostic interviews and Life Chart Interview integrating diagnostic and symptom trajectories over 2 years were administered to determine an unfavorable course. RESULTS: 41.5% of the respondents had a 2-year unfavorable course trajectory without remission longer than 3 months. Adjusted analyses showed that a lower awakening response was associated with an unfavorable course (RR=0.83, p=0.03). No associations were found between evening cortisol or cortisol suppression after dexamethasone ingestion and an unfavorable course trajectory. CONCLUSIONS: Among patients with depressive or anxiety disorders, a lower cortisol awakening response - which may be indicative of underlying exhaustion of the HPA axis - predicted an unfavorable course trajectory. SN - 1873-3360 UR - https://www.unboundmedicine.com/medline/citation/23313277/Salivary_cortisol_levels_and_the_2_year_course_of_depressive_and_anxiety_disorders_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0306-4530(12)00430-1 DB - PRIME DP - Unbound Medicine ER -