Salivary Aldosterone, Cortisol, and Their Morning to Evening Slopes in Patients with Depressive Disorder and Healthy Subjects: Acute Episode and Follow-Up 6 Months after Reaching Remission

Abstract

Background/Objective: Cortisol is thought to be involved in the pathophysiology of affective disorders. Less attention has been given to other neuroendocrine factors. The aim of the present study was to test the hypothesis that adrenocortical steroids aldosterone and cortisol show different dynamic changes in the course of clinical depression with the assumption that aldosterone is a state marker of depression. Methods: A total of 78 adult subjects (39 patients with depressive disorder and 39 healthy controls) participated in a prospective non-interventional clinical study. Patients were investigated at the time of an acute episode and 6 months after reaching remission. The clinical and personal characteristics, and morning and evening salivary concentrations of aldosterone and cortisol were evaluated. Results: Patients with an acute depressive episode exhibited higher evening aldosterone and lower morning cortisol concentrations compared to healthy subjects. In these patients, both hormone concentrations showed flatter morning to evening slopes. Salivary aldosterone, but not cortisol concentrations, were lower in patients 6 months after reaching remission compared to those in the acute state. Similarly, 6 months of remission resulted in a steeper morning to evening slope of salivary aldosterone compared to the acute state. The cortisol rhythm remained dysregulated. A significant negative correlation between trait anxiety scores and morning cortisol concentrations in patients at 6 months of clinical remission was observed. Conclusion: Diurnal changes in salivary aldosterone concentrations appear to be a state marker, whilst those of cortisol a trait marker of depression.

Steroid stress hormone changes throughout the menstrual cycle: A rise in evening aldosterone concentration in early luteal phase precedes the symptoms of premenstrual syndrome

“…To date, there are no other studies investigating morning to evening aldosterone slopes in relation to PMS. Interestingly, we have described a flatter morning to evening slope for aldosterone in patients with acute depressive episode 14 and a flatter morning to midday slope in depressed children. 32 In the present study, the diurnal slopes for cortisol in women with PMS were not different from those in control women throughout the menstrual cycle.…”

“…The obtained data were first checked for normality of distribution by Shapiro-Wilk test and subsequently winsorized using a 15% two- Morning to evening slopes of aldosterone and cortisol for each participant was calculated as described previously. 14 The values of angular coefficients were analyzed by a t test for independent groups.…”

“…Depressive states and emotional premenstrual symptoms may be associated with maladaptive coping with stress situations and the enhanced release of steroid stress hormones, namely cortisol and aldosterone. 13,14 Therefore, next to the suggested involvement of sex hormones, 15 which are not the target of the present study, the above mentioned stress hormones might be considered potential players in the pathomechanisms of the PMS.…”

“…21,22 In older studies focused on PMS, this phenomenon was not taken into consideration. Despite clear evidence on anxiogenic and depresogenic effects of aldosterone 13 and the involvement of aldosterone in the course of major depression, 14,23,24 little attention has been given to potential relationship between aldosterone and emotional symptoms of the PMS.…”

Adjunct Therapy With Glycyrrhiza Glabra Rapidly Improves Outcome in Depression—A Pilot Study to Support 11-Beta-Hydroxysteroid Dehydrogenase Type 2 Inhibition as a New Target

“…It was, however, already stated by the founder of the stress concept Hans Selye (2). More recently, aldosterone has been recognized as a potential biomarker of the depressive state as supported by clinical (3)(4)(5) and preclinical data (6)(7)(8)(9)(10). Of importance is that markers of increased aldosterone action via central mineralocorticoid receptors appear to be associated with therapy resistance to standard antidepressants (11,12).…”