Department of Psychology, University of Toronto, Sidney Smith Hall, Canada M5S 3G3.
J Psychiatr Res. 2010 Feb;44(3):183-92. doi: 10.1016/j.jpsychires.2009.07.012. Epub 2009 Sep 10.
Dysregulation of hypothalamic-pituitary-adrenal axis activity in major depressive disorder has been found to normalize with successful treatment, though inconsistencies exist. To determine the magnitude of change in cortisol levels from pre to post-treatment in individuals with unipolar depression quantitative methods of meta-analysis were applied. Thirty-four studies met inclusion criteria and consisted of a total of 1049 depressed patients across study samples. The overall mean effect size of pre-post-treatment cortisol measures indicated that approximately 56% of depressed participants had similar cortisol levels before and after treatment regardless of symptom improvement. The mean effect size of pre-post cortisol measures for those who responded to treatment was larger than the mean effect size of non-responders; however, this difference did not reach statistical significance. As well, no significant differences in mean effect size of pre-post cortisol measures based on type of treatment (e.g. antidepressant vs. ECT) were found. Subtype of depressive illness and length of treatment may contribute to the magnitude of change in cortisol measure before and after treatment. Inconsistent findings within the reviewed literature may confound the overall results. The type of treatment and response to treatment do not appear to impact the magnitude of change in cortisol level pre to post-treatment. Our findings suggest that the utility of cortisol as an outcome measure may be limited to specific subsets of the depressed population, and that given the variability in HPA results between studies, it is premature to state that cortisol is not a good outcome measure.
在重度抑郁症中，已发现下丘脑-垂体-肾上腺轴活动的失调会随着成功治疗而恢复正常，尽管存在不一致的情况。为了确定单相抑郁患者治疗前后皮质醇水平的变化幅度，采用了荟萃分析的定量方法。34 项研究符合纳入标准，共有来自研究样本的 1049 名抑郁症患者。皮质醇测量值的治疗前后总体平均效应大小表明，无论症状改善与否，大约 56%的抑郁参与者在治疗前后皮质醇水平相似。对治疗有反应者的皮质醇治疗前后平均效应大小大于无反应者的平均效应大小；然而，这种差异没有达到统计学意义。同样，基于治疗类型（如抗抑郁药与 ECT），皮质醇测量值的治疗前后平均效应大小没有显著差异。抑郁障碍的亚型和治疗时间可能会影响治疗前后皮质醇测量值的变化幅度。文献综述中的不一致发现可能会混淆总体结果。治疗类型和对治疗的反应似乎不会影响皮质醇水平在治疗前后的变化幅度。我们的研究结果表明，皮质醇作为一种结果测量可能仅限于特定的抑郁人群，并且鉴于研究之间 HPA 结果的变异性，断言皮质醇不是一种好的结果测量还为时过早。
