Depression and Anxiety Correlate Differently with Salivary Free Cortisol in the Morning in Patients with Functional Somatic Syndrome

Abstract

Patients presenting with functional somatic syndrome (FSS) are common, and the symptoms are persistent and difficult to treat for doctors and costly for society. The aim of this study was to clarify the common pathophysiology of FSS, especially the relationship between hypothalamic-pituitary-adrenal (HPA) axis function and psychological characteristics of patients with FSS. The subjects were 45 patients with FSS and 29 healthy controls. Salivary free cortisol was measured in the morning, and psychological tests examining depression, anxiety and quality of life (QOL) were performed on the same day. In patients with FSS, depressive scores showed a significant negative correlation with salivary free cortisol in the morning, although in healthy controls, cortisol showed a significant positive correlation with depressive scores. In addition, the correlation between other psychological test scores and cortisol secretion in patients with FSS contrasted with that of controls. The relationship between cortisol and depression, anxiety or QOL, suggests that the HPA axis of patients with FSS is dysfunctional and does not function properly when patients with FSS are under stress. This dysfunction may explain the pathology of medically unexplained persistent symptoms of patients with FSS.

Hypothalamus-Pituitary-Adrenal Axis Hypersuppression Is Associated with Gastrointestinal Symptoms in Major Depression

“…For example, in IBS which exhibits a high degree of comorbidity with depression and anxiety disorders, 5,6 lowered secretion of ACTH and cortisol to a CRH challenge, lowered evening saliva cortisol and a lowered level of daytime ACTH secretion have been described. [9][10][11] Patients with functional somatic syndromes show negative correlations between morning saliva cortisol and depressive symptoms 48,49 and patients with major depression show a negative correlation between cortisol and somatoform dissociation. 50 Depressed patients with a comorbid somatoform disorder show an attenuated HPA-axis response to a combined dexamethasone/CRH test.…”

Overlap between functional GI disorders and other functional syndromes: what are the underlying mechanisms?

“…Results suggested attenuated pituitary and adrenocortical activity in the patient group who had lower salivary cortisol levels and a less robust response to CRH. 179 In a study by Mutsuura et al , 180 a relationship between HPA axis function and mood was reported in FD and other functional syndromes (patients had a diagnosis of either FD, IBS, chronic tension headaches, CFS, chronic pain, or other functional GI disorder) compared to healthy controls. In the patient group, there was a negative correlation with depressive mood and morning free salivary cortisol although a positive correlation was observed in healthy controls.…”

“…In the patient group, there was a negative correlation with depressive mood and morning free salivary cortisol although a positive correlation was observed in healthy controls. 180 Although these studies showed some evidence of HPA axis dysregulation in FD patients, limitations included combining FD with other functional syndrome, differences in medications used by these patients, and underlying comorbid depression/ anxiety/or stress state, which may affect cortisol levels.…”

Saliva cortisol levels and subjective stress are not associated with number of oocytes after controlled ovarian hyperstimulation in patients undergoing in vitro fertilization

“…In our hands, the intra-assay and interassay CV were <6%. Low saliva F concentrations have been associated with chronic stress, burnout, fibromyalgia, and depression (14)(15)(16). Therefore, we chose low saliva F concentrations as an indicator of chronic stress.…”