Major depression in late life is associated with both hypo- and hypercortisolemia.
BACKGROUND
In younger adults, depression has been associated with hypercortisolemia. In older depressed patients, however, both low and high cortisol levels have been reported. We examined the possibility of a U-shaped association between depression and cortisol in older people, suggesting both hypo- and hyperactivity of the hypothalamic-pituitary-adrenal axis. We also examined whether this might represent different depression subtypes.


METHODS
This population-based study included 1185 subjects aged 65 and older. Depression was measured at both diagnostic (major depression) and symptomatic (subthreshold depression) levels of caseness. Plasma concentrations of cortisol (CORT) and corticosteroid binding globulin (CBG) were determined. From these (CORT/CBG), a free cortisol index (FCI) was computed.


RESULTS
The association between cortisol and major depression was U-shaped (B CORT = -9.50 [SE 3.85] p = .014; B CORT(2) = .008 [SE .003] p = .021). Hypocortisolemic depression (lower cortisol tertile) was associated with female sex, joint diseases, and smoking. Hypercortisolemic (upper cortisol tertile) depression was associated with older age, male sex, cardiovascular diseases, nonsteroidal antiinflammatory use, and (borderline significant) cognitive impairment.


CONCLUSIONS
In older people, the association between cortisol and major depression is U-shaped. Hypo- and hypercortisolemic depression may represent different depression subtypes, requiring different clinical management.
Bremmer
Marijke A
MA
Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands. ma.bremmer@vumc.nl
Deeg
Dorly J H
DJ
Beekman
Aartjan T F
AT
Penninx
Brenda W J H
BW
Lips
Paul
P
Hoogendijk
Witte J G
WJ
D000309:Adrenal Insufficiency / Q000150:complications* / Q000378:metabolism; D000308:Adrenocortical Hyperfunction / Q000150:complications* / Q000378:metabolism; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D018672:Community Health Planning; D003865:Major Depressive Disorder / Q000145:classification / Q000150:complications* / Q000378:metabolism*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D011569:Psychiatric Status Rating Scales; D014156:Transcortin / Q000378:metabolism
D014156:Transcortin; D006854:Hydrocortisone