Rhebergen D, Korten N C M, Penninx B W J H, Stek M L, van der Mast R C, Oude Voshaar R, Comijs H C
GGZ inGeest/Department of Psychiatry and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
Department of Epidemiology and Biostatistics and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
Psychoneuroendocrinology. 2015 Jan;51:341-50. doi: 10.1016/j.psyneuen.2014.10.005. Epub 2014 Oct 12.
Altered functioning of the hypothalamic-pituitary-adrenal axis (HPA-axis) has been associated with depression, but findings have been inconsistent. Among older depressed persons, both hyperactivity and hypo-activity of the HPA-axis were demonstrated. However, most studies were population-based studies, with single cortisol measurements, lacking insight into diurnal patterns of HPA-axis functioning. We aim to provide insight into functioning of the HPA-axis, assessed by various salivary cortisol samples, in depressed older adults and non-depressed controls.
Data were derived from the Netherlands Study of Depression in Older Persons. Cortisol levels of older persons without a lifetime diagnosis of depression and/or anxiety (n=109) were compared with older persons with a 6-month major depression diagnosis (n=311). ANCOVA analyses and random coefficient analysis on the four morning cortisol samples were performed. A possible U-shaped association between cortisol and depression status was examined.
Depressed older persons showed higher morning cortisol levels at awakening (T1) and a less dynamic awakening response compared to non-depressed older persons. Dexamethasone suppression did not differ across groups. No U-shaped association between HPA-axis activity and depression was observed.
We demonstrated a hypercortisolemic state and a diminished ability to respond to the stress of awakening among depressed older persons. Previously it was shown, that hypercortisolemic states may indicate a lifelong biological vulnerability for depression. Our findings expand on previous literature by demonstrating that in older persons the HPA-axis may become less responsive to stress, culminating in a further dysregulation of the diurnal cortisol-rhythm, superimposed on - possibly lifelong - hypercortisolemic states.
下丘脑 - 垂体 - 肾上腺轴（HPA 轴）功能改变与抑郁症有关，但研究结果并不一致。在老年抑郁症患者中，已证实 HPA 轴存在功能亢进和功能减退的情况。然而，大多数研究是基于人群的研究，仅进行单次皮质醇测量，缺乏对 HPA 轴功能昼夜模式的深入了解。我们旨在通过各种唾液皮质醇样本评估，深入了解老年抑郁症患者和非抑郁症对照组中 HPA 轴的功能。
数据来源于荷兰老年人抑郁症研究。将无终生抑郁症和/或焦虑症诊断的老年人（n = 109）的皮质醇水平与有 6 个月重度抑郁症诊断的老年人（n = 311）进行比较。对四个早晨皮质醇样本进行协方差分析和随机系数分析。研究了皮质醇与抑郁状态之间可能的 U 型关联。
与非抑郁老年人相比，抑郁老年人在觉醒时（T1）早晨皮质醇水平更高，觉醒反应的动态变化更小。地塞米松抑制在各组之间没有差异。未观察到 HPA 轴活性与抑郁症之间的 U 型关联。
我们证明了抑郁老年人存在高皮质醇血症状态，且对觉醒应激的反应能力下降。先前的研究表明，高皮质醇血症状态可能表明抑郁症存在终生生物学易感性。我们的研究结果扩展了先前的文献，表明在老年人中，HPA 轴可能对应激的反应性降低，最终导致昼夜皮质醇节律进一步失调，叠加在可能终生的高皮质醇血症状态之上。
