The cortisol awakening response at admission to hospital predicts depression severity after discharge in MDD patients

Eikeseth, Fillip Ferreira; Denninghaus, Sabrina; Cropley, Mark; Witthöft, Michael; Pawelzik, Markus R.; Sütterlin, Stefan

doi:10.1016/j.jpsychires.2019.01.002

Cited by 8 publications

(24 citation statements)

References 29 publications

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“…Whether some of the explanations for these differences in CAR characteristics are also linked to antidepressants remains to be tested. In the study by Eikeseth et al [25], only around half of the participants were in psychotropic treatment, whereas in our study, all participants were treated with duloxetine. In a study investigating CAR in healthy volunteers, treatment with escitalopram reduced CAR levels compared to placebo treatment.…”

Section: Discussionmentioning

confidence: 59%

“…The prediction of depression severity by CAR measures seems to depend on the depression characteristics as a blunted CAR has also been found to be a predictor of more depression symptoms at follow-up [25]. A tentative summary of the results could be that patients with treatment-resistant depression tend to have a more blunted CAR and more prone to less treatment improvement, and patients with less severe, nonresistant depression tend to have higher CAR as a marker of more acute stress, also predicting less treatment improvement.…”

Section: Discussionmentioning

confidence: 99%

“…A more recent study showed that high CAR levels predicted more depressive symptoms in adolescents at the 12-month follow-up [24]. A study from 2019 showed that in patients with a major depressive episode referred for psychotherapy treatment, a blunted CAR was associated with higher levels of self-reported depression levels after 6 weeks and after 6 months [25]. Finally, a study from 2015 with CAR results from a sample of complex patients (treatment-resistant depression) showed that higher CAR AUC I was associated with better treatment response of a recovery-focused milieu program [26].…”

Section: Introductionmentioning

confidence: 99%

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Salivary Cortisol Awakening Response as a Predictor for Depression Severity in Adult Patients with a Major Depressive Episode Performing a Daily Exercise Program

Refsgaard¹,

Schmedes²,

Martiny³

2022

Neuropsychobiology

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Introduction: The hypothalamic-pituitary-adrenal axis function in depression has been the subject of considerable interest, and its function has been tested with a variety of methods. We investigated associations between saliva cortisol at awakening and the 24-h urine cortisol output, both measured at study baseline, with endpoint depression scores. Methods: Patients were admitted to a psychiatric inpatient ward with a major depressive episode and were started on fixed duloxetine treatment. They delivered saliva samples at awakening and 15, 30, and 60 min post-awakening and sampled urine for 24 h. Subsequently, they started a daily exercise program maintained for a 9-week period. Clinician-rated depression severity was blindly assessed with the Hamilton Depression Rating 6-item subscale (HAM-D6). The cortisol awakening response was quantified by the area under the curve with respect to the ground (AUCG) and with respect to the rise (AUCI) using saliva cortisol levels in the 1-h period after awakening. Analysis of expected associations between depression severity, AUCG, AUCI, exercise, and 24-h cortisol output was performed in a general linear model. Results: In all, 35 participants delivered saliva or 24-h urine samples. The mean age was 49.0 years (SD = 11.0) with 48.6% females with a mean baseline HAM-D6 score of 12.2 (SD = 2.3). In a statistical model investigating the association between HAM-D6 at week 9 as a dependent variable and AUCI, concurrent HAM-D6, gender, smoking, and exercise volume as covariates, we found a significant effect of AUCI, concurrent HAM-D6, and exercise. The following statistics were found: AUCI (regression coefficient 0.008; F value = 9.1; p = 0.007), concurrent HAM-D6 (regression coefficient 0.70; F value = 8.0; p = 0.01), and exercise (regression coefficient −0.005; F value = 5.7; p = 0.03). The model had an R2 of 0.43. The association between HAM-D6 endpoint scores and the AUCI showed that higher AUCI values predicted higher HAM-D6 endpoint values. The association between HAM-D6 endpoint scores and the exercise level showed that a high exercise level was associated with lower HAM-D6 endpoint values. Conclusion: The results thus showed that high AUCI values predicted less improvement of depression and high exercise levels predicted more improvement of depression. These findings need to be confirmed in larger samples to test if more covariates can improve prediction of depression severity.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Salivary Cortisol Awakening Response as a Predictor for Depression Severity in Adult Patients with a Major Depressive Episode Performing a Daily Exercise Program

Refsgaard¹,

Schmedes²,

Martiny³

2022

Neuropsychobiology

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“…Therefore the purpose of this study is to analyze the CAR during the first days of hospitalization prior to a naturalistic inpatient psychotherapeutic treatment to predict long-term treatment outcome in MDD. We do this by replicating our previous study from Eikeseth et al (2019) following a now stricter measurement and monitoring protocol (CAR measurement and monitoring protocol as suggested by Stalder et al, 2016). While Eikeseth et al (2019) measured the CAR two times in the morning (awakening and 30 min after awakening), this assessment protocol could be criticized for potentially missing the CAR preak, even though that at least 50% mean cortisol increase occurs within the first 30 min after awakening (Pruessner et al, 1997;Wüst et al, 2000).…”

Section: Need Of Replication Studymentioning

confidence: 87%

“…We do this by replicating our previous study from Eikeseth et al (2019) following a now stricter measurement and monitoring protocol (CAR measurement and monitoring protocol as suggested by Stalder et al, 2016). While Eikeseth et al (2019) measured the CAR two times in the morning (awakening and 30 min after awakening), this assessment protocol could be criticized for potentially missing the CAR preak, even though that at least 50% mean cortisol increase occurs within the first 30 min after awakening (Pruessner et al, 1997;Wüst et al, 2000). The replicating study uses a longer measurement interval and three samples to determine a more robust way of calculating CAR as area under the curve to predict depressive symptoms 6 weeks and 6 months after discharge.…”

Section: Need Of Replication Studymentioning

confidence: 87%

The cortisol awakening response at admission to hospital predicts depression severity after discharge in major depressive disorder patients—A replication study

Neyer¹,

Witthöft²,

Cropley³

et al. 2022

Front. Neurosci.

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The cortisol awakening response (CAR) is a non-invasive biomarker for hypothalamic-pituitary-adrenal axis (HPA) dysregulation, reflecting accumulated stress over time. In a previous study we reported that a blunted CAR before an inpatient treatment predicted self-reported depressive symptoms six weeks and six months after discharge [Eikeseth, F. F., Denninghaus, S., Cropley, M., Witthöft, M., Pawelzik, M., & Sütterlin, S. (2019). The cortisol awakening response at admission to hospital predicts depression severity after discharge in major depressive disorder (MDD) patients. Journal of Psychiatric Research, 111, 44-50)]. This replication study adopted an improved overall methodology with more stringent assessment protocols and monitoring. The longitudinal design included 122 inpatients from a psychosomatic hospital with a diagnosis of MDD displaying symptoms of moderate to severe major depression (n = 80 females). The CAR was measured at intake. Depression severity was assessed as Beck Depression Inventory II scores at intake, discharge, 6 weeks and 6 months following discharge. Results from the original study were replicated in terms of effect size but did not reach statistical significance (correlation between BDI-II 6 months after discharge and AUCg: r = −0.213; p = 0.054). The replication study yielded nearly identical correlation coefficients as in the original study (BDI-II 6 months and CAR, r = −0.223, p < 0.05). The replication of previously reported effect sizes with a concurrent lack of statistical significance in the more restrictive, larger and better controlled replication study may well inform research on psycho-endocrinological predictors for treatment success, but suggests a rather limited practical relevance for cortisol awakening response measures in this clinical context.

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The role of childhood maltreatment in cortisol in the hypothalamic–pituitary–adrenal (HPA) axis in methamphetamine-dependent individuals with and without depression comorbidity and suicide attempts

Pirnia

Khosravani

Maleki

et al. 2020

Journal of Affective Disorders

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The cortisol awakening response at admission to hospital predicts depression severity after discharge in MDD patients

Cited by 8 publications

References 29 publications

Salivary Cortisol Awakening Response as a Predictor for Depression Severity in Adult Patients with a Major Depressive Episode Performing a Daily Exercise Program

Salivary Cortisol Awakening Response as a Predictor for Depression Severity in Adult Patients with a Major Depressive Episode Performing a Daily Exercise Program

The cortisol awakening response at admission to hospital predicts depression severity after discharge in major depressive disorder patients—A replication study

The role of childhood maltreatment in cortisol in the hypothalamic–pituitary–adrenal (HPA) axis in methamphetamine-dependent individuals with and without depression comorbidity and suicide attempts

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