Transcript POSHORI

Depression and dysregulation of the HPA-axis
Preliminary results of the Netherlands Study of Depression and Anxiety
SA Vreeburg1, BP Kruijtzer2, J van Pelt2, R van Dyck1, FG Zitman3, RH de Rijk3, WJ Hoogendijk1, BW Penninx1
1Department
2Laboratory
of psychiatry and EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands
for Clinical Chemistry and 3Department of Psychiatry, LUMC Medical Center, Leiden, The Netherlands
Background
Preliminary results
There is a central belief that depression is associated with
hyperactivity of the HPA-axis, resulting in higher cortisol
levels. However, results are inconsistent. We examined
whether there is an association between depression and
cortisol levels in a large cohort.
Table 1: Demographics
Implications
- Dysregulation of the HPA axis is hypothesized to be one
of the key mechanisms underlying depression. This study
can provide more insight into this pathophysiological
process.
- Medication involved in HPA axis regulation is already
being developed, however the exact role of the HPA axis in
depression is unclear as is which patients would benefit
from it. This study will give more evidence for the indication
of such medication.
Controls MDD
lifetime
n=453
n=794
42.6
43.5
42.9
0.43
% Female
60.3
70.4
64.8
0.001
Mean educational level
6.0
5.6
5.2
<0.001
Mean awakening time
7:21
7:28
7:30
0.13
% Working (sampling day)
66.1
59.3
48.6
<0.001
% Smoking
23.0
36.8
38.1
<0.001
Figure 1: cortisol values on the 6 sampling times
25
Cortisol nmol/l
- Papers
- Thesis
p
Mean age
p overall
.03
20
Products
MDD
current
n=438
15
p overall
>0.20
MDD lifetime
MDD current
Controls
10
5
Methods
0
0
30
Data are from 1,655 adults (18-65 years) of the NESDA
cohort of 2,981 participants.
Major depressive disorder (MDD):
Based on MDD diagnosis (using the CIDI interview) and on
scoring on the IDS (Inventory of Depressive Symptoms),
participants were divided into three groups:
-453 controls (no anxiety/depression diagnosis, IDS < 14,
no psycho-active medication)
-794 persons with MDD lifetime (MDD prior in their life, no
current MDD )
-438 persons with MDD current (MDD in the past month,
IDS >22 )
Cortisol saliva samples: collected at awakening, 30, 45
and 60 minutes later, at 22.00h, at 23.00h and at
awakening the next morning after 0.5 mg dexamethasone
ingestion. Samples were analyzed using the E-170 random
access analyzer (Roche), competitive Electro Chemil
Luminescence Immunoassay (ECLIA).
45
60 min
Time
22.00u
23.00u
The three groups show significant differences in sex,
educational level, smoking and working on the day of cortisol
measurement (see Table 1).
Using Generalized Equations Estimation (GEE) analysis there
was a significant group by time interaction (overall p>0.001) for
the Cortisol Awakening Rise (CAR) , indicating a different CAR
for the three groups. These findings are adjusted for sex, age,
smoking, season, awakening time, use of antidepressants, BMI,
weekday and working on the day of cortisol measurement.
As shown in figure 1 the four morning cortisol values comprising
the CAR differed significantly between the three groups (overall
p=0.03), with the highest values for respondents with current
MDD and MDD prior in their life. No differences were observed
for evening cortisol levels.
Conclusion
Contact:
[email protected]
www.nesda.nl
Preliminary results of this large cohort study indicate that
depression is associated with modest, significant differences in
the Cortisol Awakening Rise.