Department of Mental Health and Psychiatry, Geneva University Hospitals, 2 chemin du Petit-Bel-Air, CH-1225 Chêne-Bourg, Geneva, Switzerland.
J Psychiatr Res. 2012 Jan;46(1):80-6. doi: 10.1016/j.jpsychires.2011.09.011. Epub 2011 Oct 6.
Few studies have examined changes of diurnal cortisol profiles prospectively, in relation to non-pharmacological interventions such as mindfulness-based cognitive therapy (MBCT). Fifty-six patients remitted from recurrent depression (≥3 episodes) were included in an 8-week randomized controlled trial comparing MBCT plus treatment as usual (TAU) with TAU for depression relapse prophylaxis. Saliva samples (0, 15, 30, 45, 60 min post-awakening, 3 PM, 8 PM) were collected on six occasions (pre- and post-intervention, 3-, 6-, 9-, 12-month follow-up). Cortisol awakening response (CAR), average day exposure (AUCday) and diurnal slope were analyzed with mixed effects models (248 profiles, 1-6 per patient). MBCT (n = 28) and TAU groups (n = 28) did not significantly differ with respect to baseline variables. Intra-individual variability exceeded inter-individual variability for the CAR (62.2% vs. 32.5%), AUC(day) (30.9% vs. 23.6%) and diurnal slope (51.0% vs. 34.2%). No time, group and time by group effect was observed for the CAR and diurnal slope. A significant time effect (p = 0.003) was detected for AUCday, which was explained by seasonal variations (p = 0.012). Later wake-up was associated with lower CAR (-11.7% per 1-hour later awakening, p < 0.001) and lower AUCday (-4.5%, p = 0.014). Longer depression history was associated with dampened CAR (-15.2% per 10-year longer illness, p = 0.003) and lower AUCday (-8.8%, p = 0.011). Unchanged cortisol secretion patterns following participation in MBCT should be interpreted with regard to large unexplained variability, similar relapse rates in both groups and study limitations. Further research is needed to address the scar hypothesis of diminished HPA activity with a longer, chronic course of depression.
很少有研究前瞻性地研究日间皮质醇谱的变化，与非药物干预措施如基于正念的认知疗法（MBCT）有关。56 名从复发性抑郁症（≥3 次发作）中缓解的患者被纳入一项为期 8 周的随机对照试验，比较 MBCT 加常规治疗（TAU）与 TAU 预防抑郁症复发。在六个时间点（干预前和干预后、3 个月、6 个月、9 个月、12 个月随访）采集了 6 次唾液样本（唤醒后 0、15、30、45、60 分钟、下午 3 点、晚上 8 点）。使用混合效应模型分析皮质醇觉醒反应（CAR）、平均日暴露量（AUCday）和日间斜率（248 个剖面，每个患者 1-6 个）。MBCT（n=28）和 TAU 组（n=28）在基线变量方面无显著差异。CAR（62.2% vs. 32.5%）、AUCday（30.9% vs. 23.6%）和日间斜率（51.0% vs. 34.2%）的个体内变异性超过个体间变异性。CAR 和日间斜率均未观察到时间、组和时间与组之间的影响。AUCday 观察到显著的时间效应（p=0.003），这与季节性变化有关（p=0.012）。唤醒时间越晚，CAR 越低（唤醒时间每延迟 1 小时，CAR 降低 11.7%，p<0.001），AUCday 越低（-4.5%，p=0.014）。抑郁病史较长与 CAR 减弱（每增加 10 年疾病，CAR 减弱 15.2%，p=0.003）和 AUCday 降低（-8.8%，p=0.011）有关。MBCT 参与后皮质醇分泌模式不变，应考虑到个体间变异较大、两组复发率相似和研究局限性。需要进一步研究来解决 HPA 活动减弱的假说，即随着抑郁的慢性病程延长。
