BACKGROUND: Hypothalamic-pituitary-adrenal (HPA) axis abnormalities have been reported in bipolar disorder and also in suicidal behavior, but few studies have examined the relationship between suicidal behaviors and the HPA axis function in bipolar disorder, attending to and minimizing confounding factors. We compare HPA axis activity in bipolar individuals with and without suicidal behavior and unaffected healthy controls through measurement of salivary cortisol. METHOD: Salivary cortisol was collected for three consecutive days in 29 controls, 80 bipolar individuals without a history of suicide and 56 bipolar individuals with a past history of suicide. Clinical factors that affect salivary cortisol were also examined. RESULTS: A past history of suicide was associated with a 7.4% higher bedtime salivary cortisol level in bipolar individuals. There was no statistical difference between non-suicidal bipolar individuals and controls in bedtime salivary cortisol and awakening salivary cortisol was not different between the three groups. LIMITATIONS: The measure of salivary cortisol was a home based collection by the study subjects and the retrospective clinical data was primarily based on their historical account. CONCLUSIONS: Bipolar individuals with a past history of suicidal behavior exhibit hyperactivity in the HPA axis. This biological marker remains significant regardless of demographic factors, mood state, severity and course of illness. This finding in bipolar disorder is consistent with the evidence for altered HPA axis functioning in suicide and mood disorders and is associated with a clinical subgroup of bipolar patients at elevated risk for suicide based on their history, and in need of further attention and study.
BACKGROUND:Hypothalamic-pituitary-adrenal (HPA) axis abnormalities have been reported in bipolar disorder and also in suicidal behavior, but few studies have examined the relationship between suicidal behaviors and the HPA axis function in bipolar disorder, attending to and minimizing confounding factors. We compare HPA axis activity in bipolar individuals with and without suicidal behavior and unaffected healthy controls through measurement of salivary cortisol. METHOD: Salivary cortisol was collected for three consecutive days in 29 controls, 80 bipolar individuals without a history of suicide and 56 bipolar individuals with a past history of suicide. Clinical factors that affect salivary cortisol were also examined. RESULTS: A past history of suicide was associated with a 7.4% higher bedtime salivary cortisol level in bipolar individuals. There was no statistical difference between non-suicidal bipolar individuals and controls in bedtime salivary cortisol and awakening salivary cortisol was not different between the three groups. LIMITATIONS: The measure of salivary cortisol was a home based collection by the study subjects and the retrospective clinical data was primarily based on their historical account. CONCLUSIONS: Bipolar individuals with a past history of suicidal behavior exhibit hyperactivity in the HPA axis. This biological marker remains significant regardless of demographic factors, mood state, severity and course of illness. This finding in bipolar disorder is consistent with the evidence for altered HPA axis functioning in suicide and mood disorders and is associated with a clinical subgroup of bipolar patients at elevated risk for suicide based on their history, and in need of further attention and study.
Authors: F Duval; M C Mokrani; H Correa; P Bailey; M Valdebenito; J Monreal; M A Crocq; J P Macher Journal: Psychoneuroendocrinology Date: 2001-07 Impact factor: 4.905
Authors: Nadine M Melhem; John G Keilp; Giovanna Porta; Maria A Oquendo; Ainsley Burke; Barbara Stanley; Thomas B Cooper; J John Mann; David A Brent Journal: Neuropsychopharmacology Date: 2015-10-09 Impact factor: 7.853
Authors: Ayal Schaffer; Erkki T Isometsä; Leonardo Tondo; Doris H Moreno; Mark Sinyor; Lars Vedel Kessing; Gustavo Turecki; Abraham Weizman; Jean-Michel Azorin; Kyooseob Ha; Catherine Reis; Frederick Cassidy; Tina Goldstein; Zoltán Rihmer; Annette Beautrais; Yuan-Hwa Chou; Nancy Diazgranados; Anthony J Levitt; Carlos A Zarate; Lakshmi Yatham Journal: Aust N Z J Psychiatry Date: 2015-07-16 Impact factor: 5.744
Authors: Amy T Peters; Anna Van Meter; Patrick J Pruitt; Emily M Briceño; Kelly A Ryan; Melissa Hagan; Anne L Weldon; Michelle T Kassel; Aaron Vederman; Jon-Kar Zubieta; Melvin McInnis; Sara L Weisenbach; Scott A Langenecker Journal: Psychoneuroendocrinology Date: 2016-07-22 Impact factor: 4.905
Authors: Daniel C Mathews; Erica M Richards; Mark J Niciu; Dawn F Ionescu; Joseph J Rasimas; Carlos A Zarate Journal: Transl Neurosci Date: 2013-06 Impact factor: 1.757
Authors: Alan R Prossin; Matthew Chandler; Kelly A Ryan; Erika F Saunders; Masoud Kamali; Vassilios Papadopoulos; Sebastian Zöllner; Robert Dantzer; Melvin G McInnis Journal: Psychoneuroendocrinology Date: 2018-01-31 Impact factor: 4.905