Dedovic Katarina, Ngiam Janice
Department of Psychiatry, Douglas Hospital Research Centre, Montreal, QC, Canada ; Social and Affective Neuroscience Laboratory, University of California, Los Angeles, CA, USA.
Department of Psychology, McGill University, Montreal, QC, Canada.
Neuropsychiatr Dis Treat. 2015 May 14;11:1181-9. doi: 10.2147/NDT.S62289. eCollection 2015.
A vast body of literature has revealed that dysregulation of the hypothalamic-pituitary-adrenal (HPA) stress axis is associated with etiology of major depressive disorder (MDD). There are many ways that the dysregulation of the HPA axis can be assessed: by sampling diurnal basal secretion and/or in response to a stress task, pharmacological challenge, and awakening. Here, we focus on the association between cortisol awakening response (CAR), as one index of HPA axis function, and MDD, given that the nature of this association is particularly unclear. Indeed, in the following selective review, we attempt to reconcile sometimes-divergent evidence of the role of CAR in the pathway to depression. We first examine association of CAR with psychological factors that have been linked with increased vulnerability to develop depression. Then, we summarize the findings regarding the CAR profile in those with current depression, and evaluate evidence for the role of CAR following depression resolution and continued vulnerability. Finally, we showcase longitudinal studies showing the role of CAR in predicting depression onset and recurrence. Overall, the studies reveal an important, but complex, association between CAR and vulnerability to depression.
大量文献表明，下丘脑-垂体-肾上腺（HPA）应激轴功能失调与重度抑郁症（MDD）的病因有关。评估HPA轴功能失调的方法有很多：通过采集昼夜基础分泌样本和/或对应激任务、药物激发试验及觉醒的反应来评估。鉴于这种关联的性质特别不明确，在此我们重点关注作为HPA轴功能指标之一的皮质醇觉醒反应（CAR）与MDD之间的关联。事实上，在以下的选择性综述中，我们试图调和关于CAR在抑郁症发病途径中作用的一些有时相互矛盾的证据。我们首先研究CAR与那些与患抑郁症易感性增加相关的心理因素之间的关联。然后，我们总结当前抑郁症患者中CAR特征的研究结果，并评估抑郁症缓解后CAR的作用及持续易感性的证据。最后，我们展示纵向研究，以说明CAR在预测抑郁症发作和复发中的作用。总体而言，这些研究揭示了CAR与抑郁症易感性之间重要但复杂的关联。
