Cortisol as a predictor of psychological therapy response in depressive disorders: Systematic review and meta-analysis

Fischer, Susanne; Strawbridge, Rebecca; Herane-Vives, Andrés; Cleare, Anthony J.

doi:10.1192/bjp.bp.115.180653

Cited by 95 publications

(59 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This indicates that basal cortisol level is unlikely to be influenced by ICBT intervention. This was supported by findings of a recent systematic review and meta-analysis that investigated if cortisol level could be a predictor of treatment response to psychological therapy in depression [33]. However, because of the limited sample size, our findings should be considered as preliminary.…”

Section: Discussionsupporting

confidence: 82%

Exercise Reduces Salivary Morning Cortisol Levels in Patients with Depression

et al. 2018

View full text Add to dashboard Cite

Purpose of the Study: Cortisol hypersecretion plays a role in depression pathophysiology. Internet-based cognitive behavioural therapy (ICBT) and physical exercise (PE) are new treatment alternatives for depression, and their long-lasting effect on cortisol is unknown. We investigated cortisol level changes after 12 weeks of ICBT, PE or treatment as usual (TAU). Procedures: The present pre-post repeated measure study analysed data derived from a randomised controlled trial evaluating the effects of 12 weeks’ interventions of ICBT, PE and TAU in depressed primary care patients (Sweden 2011–2013) and aimed at prospectively evaluating the within-group effects of ICBT, PE and TAU on diurnal salivary cortisol levels in a small representative subsample (n = 56, 38 and 27, respectively). Results: We found a marked flattening of the diurnal cortisol slope (p = 0.004) and a reduced cortisol level at awakening (p = 0.017) after 12 weeks of PE treatment. No apparent effects of ICBT or TAU interventions were seen on diurnal cortisol levels. Conclusions and Message: PE reduced the rate of cortisol level decline across the day in depressed adults. ICBT and TAU treatments had no detectable effects on diurnal cortisol levels. Larger samples are required for the detection and comparison of smaller effects of PE, ICBT and TAU on diurnal cortisol levels.

show abstract

Section: Discussionsupporting

confidence: 82%

Exercise Reduces Salivary Morning Cortisol Levels in Patients with Depression

et al. 2018

View full text Add to dashboard Cite

show abstract

“…This is supported by a recent review of chronic cortisol levels measured in hair, supporting the hypothesis of cortisol hyperactivity in depression but hypoactivity in other illnesses such as panic disorder 106. Furthermore, particularly, elevated cortisol levels may predict a poorer response to psychological107 and antidepressant108 treatment. Historically, the most promising neuroendocrine marker of prospective treatment response has been the dexamethasone suppression test, where cortisol nonsuppression following dexamethasone administration is associated with a lower likelihood of subsequent remission.…”

Section: Introductionmentioning

confidence: 66%

Biomarkers for depression: recent insights, current challenges and future prospects

Strawbridge¹,

Young²,

Cleare³

2017

NDT

Self Cite

299

156

View full text Add to dashboard Cite

A plethora of research has implicated hundreds of putative biomarkers for depression, but has not yet fully elucidated their roles in depressive illness or established what is abnormal in which patients and how biologic information can be used to enhance diagnosis, treatment and prognosis. This lack of progress is partially due to the nature and heterogeneity of depression, in conjunction with methodological heterogeneity within the research literature and the large array of biomarkers with potential, the expression of which often varies according to many factors. We review the available literature, which indicates that markers involved in inflammatory, neurotrophic and metabolic processes, as well as neurotransmitter and neuroendocrine system components, represent highly promising candidates. These may be measured through genetic and epigenetic, transcriptomic and proteomic, metabolomic and neuroimaging assessments. The use of novel approaches and systematic research programs is now required to determine whether, and which, biomarkers can be used to predict response to treatment, stratify patients to specific treatments and develop targets for new interventions. We conclude that there is much promise for reducing the burden of depression through further developing and expanding these research avenues.

show abstract

“…Stetler et al (2011), for example, found that higher cortisol levels were evident with a moderate effect size in MDD using meta-analysis. Prior studies of cortisol as a predictor of MDD treatment with psychological (Fischer et al, 2017) and antidepressant treatment (Kin et al, 1997) have suggested that higher levels are a poor prognostic sign. To our knowledge, this is the first report to suggest that lower cortisol in older adults might be diagnostic and a poor prognostic indicator.…”

Section: Discussionmentioning

confidence: 99%

“…Because of the immense and growing cost of Major Depressive Disorder (MDD) to individuals (Ferrari et al, 2013) and society (Greenberg et al, 2015), uncovering physiological biomarkers associated with depression that may predict treatment response is of high importance. Data accumulated over four decades of research indicate that the hypothalamicpituitary-adrenal (HPA) axis plays a key role in the pathophysiology of MDD (Stetler and Miller, 2011;Wolkowitz et al, 2009) and might have utility for prediction of depression symptom outcome to psychological treatments (Fischer et al, 2017). However, inconsistent results in the relationship between HPA axis markers such as cortisol and MDD suggest the presence of moderators such as age (Stetler and Miller, 2011).…”

Section: Introductionmentioning

confidence: 99%

Cortisol Predicts Antidepressant Treatment Outcome, Memory Improvement, and Brain Response to Negative Emotions: The Importance of Aging

Jain

Connolly²,

Reus

et al. 2018

Preprint

View full text Add to dashboard Cite

Background: Studies testing the relationship between cortisol levels, depression, and antidepressant treatment response have yielded divergent results suggesting the possibility of moderators of a cortisol effect. Several studies indicate that age may moderate the relationship between cortisol and psychopathology. In patients with Major Depressive Disorder (MDD), we studied the interactive effects of age and cortisol on predicting diagnostic status, improvement in mood and memory function with antidepressant treatment, and brain response to negative emotional stimuli. Methods: 66 unmedicated patients with MDD and 75 matched healthy controls had serum assayed at pre-treatment baseline for cortisol. Logistic regression was used to determine an association of age, cortisol and their interaction with MDD diagnosis. Thirty-four of the MDD participants (age range: 19-65 years; median: 36) underwent treatment with a selective serotonin reuptake inhibitor (SSRl) for 8 weeks. Clinician and self-ratings of depression symptoms, as well as tests of verbal and visual delayed recall were obtained at baseline and post treatment. Moderation analyses determined the effect of age on the relationship between baseline cortisol and treatment outcome. A separate sample of 8 MDD participants prospectively underwent fMRI neuroimaging and cortisol collection while viewing negative emotional faces.Results: Age moderated the effects of cortisol on predicting MDD diagnosis (p<.05), treatmentassociated reduction of depression symptoms (p<.001), improvement of delayed recall (p<.001), and baseline brain response to negative emotions (p<.05, whole brain corrected). Modeling the Age X Cortisol interaction suggested that for the participants below the median age of our sample, lower cortisol levels predicted a lower rate of MDD diagnosis, higher antidepressant effects and decreased brain reactivity in emotion regulation regions such as the anterior cingulate gyrus. On the contrary, in those above the median sample age, lower cortisol predicted a higher rate of MDD, less improvement in depression symptoms and memory performance, and more brain reactivity in the anterior cingulate. Conclusions:Our results indicate that age moderates the relationship between peripheral cortisol levels and (1) MDD diagnosis, (2) brain reactivity to emotional stimuli, and (3) antidepressant-associated improvement in depression and memory symptoms. These results 3 indicate that previous disparities in the literature linking peripheral cortisol levels with depression characteristics and treatment response may critically relate, at least in part, to the age of the patients studied.

show abstract

Cortisol as a predictor of psychological therapy response in depressive disorders: Systematic review and meta-analysis

Abstract: Our findings suggest that patients with depression with elevated HPA functioning are less responsive to psychological therapy.

Cited by 95 publications

References 27 publications

Exercise Reduces Salivary Morning Cortisol Levels in Patients with Depression

Exercise Reduces Salivary Morning Cortisol Levels in Patients with Depression

Biomarkers for depression: recent insights, current challenges and future prospects

Cortisol Predicts Antidepressant Treatment Outcome, Memory Improvement, and Brain Response to Negative Emotions: The Importance of Aging

Contact Info

Product

Resources

About