Association of serum cortisol level with severity of depression and improvement in newly diagnosed patients with major depressive disorder in Jimma medical center, Southwest Ethiopia

Abstract

Background Major Depressive Disorder (MDD) is the leading psychiatric disorder in low- and middle-income countries, and is to be the second leading cause of burden of disease by 2020. Cortisol plays a significant role in pathophysiology of MDD. Depression can alter serum cortisol level. However, the change in serum cortisol level and its association with depressive symptom severity and improvement among patients with MDD is not well studied. Objective To outline change in serum cortisol levels and its association with severity and improvement of depressive symptoms in newly diagnosed patients with MDD. Method Hospital based longitudinal study was conducted among 34 newly diagnosed patients who met DSM-V criteria of MDD. Venous blood sample was performed twice; pre- and post- 8 weeks of treatment. Serum cortisol concentration was measured using an extracted radioimmunoassay. The 17-item Hamilton Depression Scale (HAM-D) was used to rate depression at baseline and after 8 weeks of treatment. Paired t-test was done to look the mean difference of serum cortisol level and HAM-D, before and after treatment. Pearson correlation was done to look the association between serum cortisol levels, HAM-D scores and, sociodemographic and clinical factors. Statistical significance was set at p<0.05. Results There is no significant difference in cortisol concentrations at baseline and end line (t (33) = 2.02, p = 0.052). However, there is significant difference in HAM-D total score (t (33) = 5.67, p<0.001). Baseline and end line serum cortisol levels were significantly correlated (r = .561, p = .001). Monthly family income is correlated with baseline HAM-D total score (r = -0.373, p = .030). There is no significant relationship between baseline serum cortisol level and HAM-D score. There is also no significant relationship between end line serum cortisol level and HAM-D score. Conclusions The symptoms of MDD were reduced following treatment but there is no significant difference in serum cortisol levels. Baseline and end line serum cortisol levels were significantly correlated. We recommend further research based on large sample.

The relationship between the changes in inflammatory parameters and response to treatment in major depression patients starting antidepressant treatment

“…In the present study there was no relationship between the changes in cortisol levels and treatment response during MDD therapy. Consistent with this study, the findings by Alenko et al did not show an association between serum cortisol levels and treatment response to SSRI [30]. There are many parameters in the measurement of cortisol and other stress hormones that are very difficult to control, such as sample collection time and exercise.…”

Prenatal Exposure to High Cortisol Induces ADHD-like Behaviors with Delay in Spatial Cognitive Functions during the Post-weaning Period in Rats

“…Cortisol is the dominant factor to determine stress-mediated depression and the repetitive injection of corticosterone elevates the level of plasma cortisol, inducing neuroendocrine dysregulation and depressive symptoms in animal studies [ 6 , 8 - 10 , 25 ]. In the present study, we injected corticosterone to pregnant rats and investigated the occurrence of behavioral abnormalities in postnatal rat pups correlated with neuropsychiatric disorders such as depression or autism.…”

“…The high level of plasma cortisol is an important biomarker of major depressive disorders clinically as the excessive stress correlated with human depression elevates the cortisol level [ 25 , 26 ]. Therefore, it has been believed that constant exposure to external stressors may affect the neuroendocrine system of brain and induce neurochemical dysregulation resulting in neuropsychiatric disorders [ 5 , 6 , 26 ].…”

Potential biomarkers of major depression diagnosis and chronicity

“…MDD is a multifactorial disorder with a complex pathophysiology: neither the biological changes are similar in all patients nor do they evolve with the same intensity [ 2 – 4 ]. Some studies show that patients with a first depressive episode or mild MDD have a greater salivary cortisol awakening response (CAR) and serum cortisol (SC) than healthy volunteers, while they show similar levels of mature brain-derived neurotrophic factor (mBDNF) and C-reactive protein (CRP) [ 5 – 7 ]. In contrast, patients with treatment-resistant depression (TRD) have often shown lower levels of SC and CAR, and higher levels of mBDNF and CRP, when compared to healthy controls [ 5 , 8 , 9 ].…”