Depression and stress reactivity in metastatic breast cancer.
OBJECTIVE
Cancer-related distress due to the psychological and physical challenges of metastatic breast cancer (MBC) may result in symptoms of depression, which negatively affects quality and may influence quantity of life. This study investigated how depression affects MBC stress reactivity, including autonomic (ANS) and hypothalamic-pituitary-adrenal (HPA) axis function.


METHODS
Forty-five nondepressed and 45 depressed patients with MBC underwent a modified Trier Social Stress Test (TSST) while affect, cardiovascular, respiratory, and cortisol responses were measured.


RESULTS
At study entry, depressed compared with nondepressed patients had significantly lower log cortisol waking rise levels (p = .005) but no other HPA differences. Positive affect (p = .025) and high-frequency heart-rate variability (lnHF) (p = .002) were significantly lower at TSST baseline in depressed patients. In response to the TSST, depressed patients reported significantly lower positive (p = .050) and greater negative affect (p = .037) and had significantly reduced lnHF (p = .031). In secondary analyses, at TSST baseline both low-frequency (lnLF) (p = .002) and very-low-frequency (lnVLF) (p = .0001) heart rate variability were significantly lower in the depressed group. In secondary analyses during the TSST, those who were depressed had significantly lower lnVLF (p = .008) and did not increase aortic impedance reactivity as much as did the nondepressed during the stressor (p = .005).


CONCLUSIONS
Depression in patients with MBC was associated with alterations in autonomic regulation, particularly reductions in respiratory sinus arrhythmia, a measure of cardiac vagal control, at baseline and during the TSST. In addition, depression was associated with blunted HPA response to awakening. Both MBC groups had relative cortisol hyporesponsiveness to acute stress.
Giese-Davis
Janine
J
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA. jgiese@stanford.edu
Wilhelm
Frank H
FH
Conrad
Ansgar
A
Abercrombie
Heather C
HC
Sephton
Sandra
S
Yutsis
Maya
M
Neri
Eric
E
Taylor
C Barr
CB
Kraemer
Helena C
HC
Spiegel
David
D
D000302:Adrenal Cortex / Q000378:metabolism; D000328:Adult; D000339:Affect; D000368:Aged; D001341:Autonomic Nervous System / Q000503:physiopathology*; D001794:Blood Pressure; D001943:Breast Neoplasms / Q000150:complications / Q000473:pathology / Q000523:psychology*; D002245:Carbon Dioxide / Q000032:analysis; D002940:Circadian Rhythm; D003863:Depression / Q000150:complications / Q000503:physiopathology*; D017097:Electric Impedance; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis / Q000378:metabolism; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D008433:Mathematics; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009362:Neoplasm Metastasis; D010313:Partial Pressure; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D012119:Respiration; D012463:Saliva / Q000737:chemistry; D012959:Socioeconomic Factors; D013060:Speech; D013312:Stress, Physiological / Q000150:complications / Q000503:physiopathology*; D013315:Stress, Psychological / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D014630:Vagus Nerve / Q000503:physiopathology
D002245:Carbon Dioxide; D006854:Hydrocortisone