University Psychiatric Center (UPC) Duffel. Duffel, Belgium.; Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp. Antwerp, Belgium.
Department of Internal Medicine, division of Endocrinology, Erasmus MC, University Medical Center Rotterdam. Rotterdam, The Netherlands.
J Affect Disord. 2020 Sep 1;274:784-791. doi: 10.1016/j.jad.2020.05.042. Epub 2020 May 28.
There is substantial evidence showing changes in hypothalamic pituitary adrenal (HPA)-axis activity in patients with major depressive disorder (MDD). Also, there seem to be differences in HPA-axis functioning between MDD subgroups. It is however unclear whether hair cortisol concentrations (HCC), which are a stable marker of long-term cortisol levels, are suitable as a biomarker for identifying subgroups in MDD.
We were able to attain valid HCC from a scalp hair sample of sixty-two patients with a major depressive episode right before electroconvulsive therapy (ECT). HCC were our main biological outcome measure. We created subgroups using depression severity as defined by the Hamilton Depression Rating Scale, the presence/absence of psychotic symptoms, the presence of melancholia as defined by the CORE and catatonia as defined by the Bush-Francis Catatonia Rating Scale.
Our analyses of the total group showed a median HCC of 4.4 pg/mg. We found patients with catatonia (N = 10) to have substantially higher median HCC (8.3 pg/mg) than patients without catatonia (3.8 pg/mg). Although presence of melancholia and depression severity were not significantly associated with HCC, more severe psychomotor agitation was associated with higher HCC. Pre-treatment HCC was not associated with ECT outcome.
A complicating factor in interpretation of our results was the large variability in HCC. This could be related to potential confounders such as cardiometabolic and other comorbidities, that were however addressed to the extent possible.
HCC is a potential biomarker for MDD patients with severe agitation and/or catatonia. CLINICALTRIALS.GOV: Identifier: NCT02562846.
大量证据表明，患有重度抑郁症（MDD）的患者的下丘脑-垂体-肾上腺（HPA）轴活性会发生变化。此外，HPA 轴功能在 MDD 亚组之间似乎存在差异。但是，头发皮质醇浓度（HCC）是否适合作为识别 MDD 亚组的生物标志物尚不清楚，HCC 是长期皮质醇水平的稳定标志物。
我们能够从六十二名在电惊厥治疗（ECT）前患有重度抑郁发作的患者的头皮头发样本中获得有效的 HCC。HCC 是我们的主要生物学结果测量指标。我们使用汉密尔顿抑郁评定量表（Hamilton Depression Rating Scale）定义的抑郁严重程度、是否存在精神病症状、CORE 定义的忧郁症以及 Bush-Francis 紧张症评定量表（Bush-Francis Catatonia Rating Scale）定义的紧张症来创建亚组。
我们对总组的分析显示，HCC 的中位数为 4.4 pg/mg。我们发现患有紧张症（N=10）的患者的 HCC 中位数明显更高（8.3 pg/mg），而没有紧张症的患者的 HCC 中位数为 3.8 pg/mg。尽管忧郁症和抑郁严重程度与 HCC 无显著相关性，但更严重的精神运动激越与更高的 HCC 相关。治疗前 HCC 与 ECT 结果无关。
解释我们结果的一个复杂因素是 HCC 的高度变异性。这可能与潜在的混杂因素有关，如心血管代谢和其他合并症，但我们已尽可能地解决了这些因素。
HCC 是严重激越和/或紧张症的 MDD 患者的潜在生物标志物。CLINICALTRIALS.GOV：标识符：NCT02562846。
