Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany; Psychiatric Hospital of the University of Basel, Basel, Switzerland.
Psychoneuroendocrinology. 2013 Nov;38(11):2729-36. doi: 10.1016/j.psyneuen.2013.06.033. Epub 2013 Aug 8.
The purpose of this study was to investigate subjective mood and the effect of a psychosocial stress challenge on cortisol response in patients remitted from depression in comparison to healthy controls. Only few studies on small samples have been conducted on the influence of psychosocial stress on HPA system responsivity in this group. Results regarding patients who have achieved clinical remission from depression remain inconclusive so far. In comparison to healthy controls, some studies found blunted cortisol responses to a psychological stressor in patients with remitted depression. However, others found no differences. This discrepancy may be due to use of heterogeneous stress measures or dissimilar sample sizes and characteristics, e.g. including patients with comorbid generalized anxiety or patients with an unknown duration of remission. The present study included 77 healthy controls and 70 unipolar depressed patients who had achieved stable, full remission for at least 6 months (average 31 months) with no further Axis I disorder. Participants underwent the Trier Social Stress Test and salivary cortisol levels and mood were assessed repeatedly during the experimental procedure. For both groups, we observed a marked cortisol response and worsening of mood after the stress challenge. However, no differences between formerly depressed patients and healthy participants were observed. Assuming a disturbed HPA system regulation in acute depression, we interpret these findings as evidence for a restored HPA axis function in fully remitted patients.
这项研究的目的是调查抑郁缓解患者的主观情绪和心理社会应激挑战对皮质醇反应的影响，并与健康对照组进行比较。只有少数关于这一群体的小样本的研究探讨了心理社会应激对 HPA 系统反应性的影响。迄今为止，关于抑郁缓解患者的研究结果仍不一致。与健康对照组相比，一些研究发现，缓解期抑郁症患者对心理应激源的皮质醇反应迟钝。然而，其他研究则没有发现差异。这种差异可能是由于使用了不同的应激测量方法或不同的样本量和特征，例如包括伴有广泛性焦虑症的患者或缓解期未知的患者。本研究包括 77 名健康对照组和 70 名单相抑郁缓解患者，他们在没有进一步的轴 I 障碍的情况下，至少稳定缓解 6 个月（平均 31 个月）。参与者接受了特里尔社会应激测试，在实验过程中多次评估唾液皮质醇水平和情绪。对于两组参与者，我们都观察到应激挑战后皮质醇水平显著升高，情绪恶化。然而，在抑郁缓解患者和健康参与者之间没有观察到差异。鉴于急性抑郁症患者的 HPA 系统调节紊乱，我们将这些发现解释为完全缓解的患者 HPA 轴功能恢复的证据。
