BACKGROUND: Increased hypothalamic-pituitary-adrenal axis activity is well described in psychotic depression with an emphasis on 24-hour, urinary free cortisol levels or dexamethasone suppression tests. There are limited data on cortisol levels during specific times of the day. METHODS: Patients with depression with (PMD) and without (NPMD) psychosis and healthy control subjects were studied using rating scales of depression and psychosis and measures of HPA activity, including overnight cortisol and adrenocorticotropin levels. We used analysis of variance to determine group differences and regression analyses to assess contributions of specific measures to cortisol levels. RESULTS: PMDs had higher cortisol during the evening hours than did NPMDs or control subjects, who did not differ from one another. Regression analyses suggest that depression and the combination of depressive and psychotic symptoms were important contributors to variance in evening cortisol. CONCLUSIONS: PMD is associated with increased cortisol levels during the quiescent hours. Enhanced cortisol activity, particularly a higher nadir, was related to depression severity and the interaction of depressive and psychotic symptoms. This increase suggests a defect in the action of the circadian timing system and HPA axis, creating a hormonal milieu similarly seen in early Cushing's syndrome and potentially an (im)balance of mineralocorticoid and glucocorticoid receptor activity.
BACKGROUND: Increased hypothalamic-pituitary-adrenal axis activity is well described in psychotic depression with an emphasis on 24-hour, urinary free cortisol levels or dexamethasone suppression tests. There are limited data on cortisol levels during specific times of the day. METHODS:Patients with depression with (PMD) and without (NPMD) psychosis and healthy control subjects were studied using rating scales of depression and psychosis and measures of HPA activity, including overnight cortisol and adrenocorticotropin levels. We used analysis of variance to determine group differences and regression analyses to assess contributions of specific measures to cortisol levels. RESULTS: PMDs had higher cortisol during the evening hours than did NPMDs or control subjects, who did not differ from one another. Regression analyses suggest that depression and the combination of depressive and psychotic symptoms were important contributors to variance in evening cortisol. CONCLUSIONS:PMD is associated with increased cortisol levels during the quiescent hours. Enhanced cortisol activity, particularly a higher nadir, was related to depression severity and the interaction of depressive and psychotic symptoms. This increase suggests a defect in the action of the circadian timing system and HPA axis, creating a hormonal milieu similarly seen in early Cushing's syndrome and potentially an (im)balance of mineralocorticoid and glucocorticoid receptor activity.
Authors: Roger S McIntyre; Ka Young Park; Candy W Y Law; Farah Sultan; Amanda Adams; Maria Teresa Lourenco; Aaron K S Lo; Joanna K Soczynska; Hanna Woldeyohannes; Mohammad Alsuwaidan; Jinju Yoon; Sidney H Kennedy Journal: CNS Drugs Date: 2010-09 Impact factor: 5.749
Authors: Linda L Carpenter; John P Carvalho; Audrey R Tyrka; Lauren M Wier; Andrea F Mello; Marcelo F Mello; George M Anderson; Charles W Wilkinson; Lawrence H Price Journal: Biol Psychiatry Date: 2007-07-27 Impact factor: 13.382
Authors: Melissa A Rosenkranz; Richard J Davidson; Donal G Maccoon; John F Sheridan; Ned H Kalin; Antoine Lutz Journal: Brain Behav Immun Date: 2012-10-22 Impact factor: 7.217
Authors: Jennifer Keller; Lin Shen; Rowena G Gomez; Amy Garrett; H Brent Solvason; Allan Reiss; Alan F Schatzberg Journal: Am J Psychiatry Date: 2008-05-01 Impact factor: 18.112