title: Lower cortisol levels in depressed patients with comorbid post-traumatic stress disorder.
abstract: Post-traumatic stress disorder (PTSD) is often comorbid with major depressive episodes (MDEs) and both conditions carry a higher rate of suicidal behavior. Hypothalamic-pituitary-adrenal (HPA) axis and serotonin abnormalities are associated with both conditions and suicidal behavior, but their inter-relation is not known. We determined cortisol response to placebo or fenfluramine in MDE, MDE and PTSD (MDE+PTSD), and healthy volunteers (HVs) and examined the relation of cortisol responses to suicidal behavior. A total of 58 medication-free patients with MDE (13 had MDE+PTSD) and 24 HVs were studied. They received placebo on the first day and fenfluramine on the second day. Cortisol levels were drawn before challenge and for 5 h thereafter. The MDE+PTSD group had the lowest plasma cortisol, the MDE group had the highest, and HVs had intermediate levels. There were no group differences in cortisol response to fenfluramine. Suicidal behavior, sex, and childhood history of abuse were not predictors of baseline or postchallenge plasma cortisol. Cortisol levels increased with age. This study finds elevated cortisol levels in MDE and is the first report of lower cortisol levels in MDE+PTSD. The findings underscore the impact of comorbidity of PTSD with MDE and highlight the importance of considering comorbidity in psychobiology.
authors.affiliation: Department of Neuroscience, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive Unit 42, New York, NY 10032, USA. moquendo@neuron.cpmc.columbia.edu
authors.forename: M A
authors.initials: MA
authors.lastname: Oquendo
authors.forename: G
authors.initials: G
authors.lastname: Echavarria
authors.forename: H C
authors.initials: HC
authors.lastname: Galfalvy
authors.forename: M F
authors.initials: MF
authors.lastname: Grunebaum
authors.forename: A
authors.initials: A
authors.lastname: Burke
authors.forename: A
authors.initials: A
authors.lastname: Barrera
authors.forename: T B
authors.initials: TB
authors.lastname: Cooper
authors.forename: K M
authors.initials: KM
authors.lastname: Malone
authors.forename: J
authors.initials: J
authors.lastname: John Mann
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D004834:Epilepsy, Post-Traumatic / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D005260:Female; D005277:Fenfluramine / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects / Q000378:metabolism; D008297:Male; D008875:Middle Aged
chemical_list: D005277:Fenfluramine; D006854:Hydrocortisone