S Fischer1,2, S King1, A Papadopoulos1, M Hotopf1,3, A H Young1,3, A J Cleare1,3. 1. Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. 2. Institute of Psychology, Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland. 3. South London and Maudsley NHS Foundation Trust, Camberwell, London, UK.
Abstract
OBJECTIVE: Around 30-50% of patients with depression and anxiety disorders fail to respond to standard psychological therapy. Given that cortisol affects cognition, patients with altered hypothalamic-pituitary-adrenal (HPA) axis functioning may benefit less from such treatments. To investigate this, reliable pretreatment cortisol measures are needed. METHOD: N = 89 outpatients with depression and anxiety disorders were recruited before undergoing therapy within an Improving Access to Psychological Therapies (IAPT) service. Three-month hair cortisol was determined, and the Childhood Trauma Questionnaire was administered. Patients were classified as responders if they showed significant decreases in depression (>= 6 points on the Patient Health Questionnaire) or anxiety (>= 5 points on the Generalised Anxiety Disorder Scale). RESULTS: Non-responders in terms of depression (57%) had lower pretreatment hair cortisol concentrations (P = 0.041) and reported more physical abuse (P = 0.024), sexual abuse (P = 0.010) and total trauma (P = 0.039) when compared to responders. Non-responders in terms of anxiety (48%) had lower pretreatment hair cortisol (P = 0.027), as well as higher levels of emotional abuse (P = 0.034), physical abuse (P = 0.042) and total trauma (P = 0.048). CONCLUSION: If future research confirms hair cortisol to be a predictor of psychological therapy response, this may prove a useful clinical biomarker which identifies a subgroup requiring more intensive treatment.
OBJECTIVE: Around 30-50% of patients with depression and anxiety disorders fail to respond to standard psychological therapy. Given that cortisol affects cognition, patients with altered hypothalamic-pituitary-adrenal (HPA) axis functioning may benefit less from such treatments. To investigate this, reliable pretreatment cortisol measures are needed. METHOD: N = 89 outpatients with depression and anxiety disorders were recruited before undergoing therapy within an Improving Access to Psychological Therapies (IAPT) service. Three-month hair cortisol was determined, and the Childhood Trauma Questionnaire was administered. Patients were classified as responders if they showed significant decreases in depression (>= 6 points on the Patient Health Questionnaire) or anxiety (>= 5 points on the Generalised Anxiety Disorder Scale). RESULTS: Non-responders in terms of depression (57%) had lower pretreatment hair cortisol concentrations (P = 0.041) and reported more physical abuse (P = 0.024), sexual abuse (P = 0.010) and total trauma (P = 0.039) when compared to responders. Non-responders in terms of anxiety (48%) had lower pretreatment hair cortisol (P = 0.027), as well as higher levels of emotional abuse (P = 0.034), physical abuse (P = 0.042) and total trauma (P = 0.048). CONCLUSION: If future research confirms hair cortisol to be a predictor of psychological therapy response, this may prove a useful clinical biomarker which identifies a subgroup requiring more intensive treatment.
Authors: Juan P Sanabria-Mazo; Carlos G Forero; Paula Cristobal-Narváez; Carlos Suso-Ribera; Azucena García-Palacios; Ariadna Colomer-Carbonell; Adrián Pérez-Aranda; Laura Andrés-Rodríguez; Lance M McCracken; Francesco D'Amico; Pere Estivill-Rodríguez; Bernat Carreras-Marcos; Antonio Montes-Pérez; Olga Comps-Vicente; Montserrat Esteve; Mar Grasa; Araceli Rosa; Antonio I Cuesta-Vargas; Michael Maes; Xavier Borràs; Silvia Edo; Antoni Sanz; Albert Feliu-Soler; Juan R Castaño-Asins; Juan V Luciano Journal: BMJ Open Date: 2020-07-23 Impact factor: 2.692