University of Groningen, Faculty of Social and Behavioral Sciences, Department of Clinical Psychology, Groningen, The Netherlands.
Psychiatry Res. 2012 Dec 30;200(2-3):281-7. doi: 10.1016/j.psychres.2012.03.044. Epub 2012 Apr 11.
Major Depressive Disorder (MDD) is a highly recurrent disease. Stress-responsive system dysfunction seems to persist after remission. In patients with more chronic and recurrent depressive episodes, state related HPA-axis dysregulation might be a risk factor for prospective recurrence. This study examines the predictive effect of cortisol on consecutive episodes in remitted recurrently depressed patients. Cortisol was assessed in saliva in remitted recurrently depressed patients (n=55) that were followed up prospectively for 5.5 years after remission. Recurrence was assessed using a well validated structured interview. Lower mean morning cortisol levels predicted earlier time to recurrence over 5.5 year after correction for residual symptoms (p=0.015). Residual symptoms and childhood trauma slightly confounded the association between cortisol and recurrence. Lower cortisol levels were associated with having experienced traumatic childhood life events (42.3% in patients with lower cortisol versus 19.2% in patients with higher cortisol). Our study provides further support for the predictive role over 5.5 year of HPA axis dysregulation, i.e. lower morning cortisol levels, of recurrence in recurrently depressed patients. Childhood trauma is associated to having lower cortisol levels. It might have long term consequences for dealing with stress and the HPA-axis.
重性抑郁障碍（MDD）是一种高复发性疾病。应激反应系统功能障碍似乎在缓解后仍持续存在。在慢性和复发性抑郁发作较多的患者中，状态相关的 HPA 轴失调可能是未来复发的一个危险因素。本研究探讨了皮质醇对缓解后复发性抑郁患者连续发作的预测作用。在缓解后，对 55 例复发性抑郁患者的唾液皮质醇进行评估，前瞻性随访 5.5 年。使用经过验证的结构化访谈评估复发。校正残留症状后（p=0.015），皮质醇平均清晨水平较低预示着复发时间更早。残留症状和儿童期创伤稍微混淆了皮质醇与复发之间的关联。皮质醇水平较低与经历过创伤性童年生活事件有关（皮质醇较低的患者中为 42.3%，皮质醇较高的患者中为 19.2%）。我们的研究进一步支持了 5.5 年内 HPA 轴失调、即清晨皮质醇水平较低与复发性抑郁患者复发的预测作用。儿童期创伤与皮质醇水平较低有关。它可能对处理压力和 HPA 轴有长期影响。
