Pituitary-adrenal and sympathetic nervous system responses to stress in women remitted from recurrent major depression.
OBJECTIVE
To better understand the changes in hypothalamus-pituitary-adrenal (HPA) axis and sympathetic nervous system (SNS) function after remission of depression. We characterized these systems at baseline and in response to a psychosocial stressor in a cohort of women remitted from recurrent major depression as well as in never-depressed healthy female controls.


METHODS
Baseline HPA function was measured via saliva cortisol sampling at 8 AM and 4 PM over 7 days as well as quantification of urinary overnight cortisol secretion. The HPA system response to a psychosocial stressor was assessed by measuring serum cortisol and adrenocorticotropic hormone (ACTH) levels and SNS reactivity by determining serum epinephrine (E) and norepinephrine (NE) concentrations as well as autonomic nervous system changes by analysis of heart rate variability (HRV). The stressor included a speech task, mental arithmetic, and a cognitive challenge.


RESULTS
In all, we studied 22 women remitted from recurrent major depression (age = 51.0 +/- 1.7 years) and 20 healthy controls (age = 54.2 +/- 1.6 years). Morning saliva cortisol concentrations were lower in remitted patients, paralleled by lower serum cortisol concentrations before stress testing. This group also displayed a blunted cortisol and ACTH response to the stressor, as compared with healthy controls. No between-group differences in HRV parameters were observed.


CONCLUSIONS
In this group of women remitted from recurrent major depressive disorder, we found evidence of HPA system hypoactivity, both in the basal state and in response to a psychosocial stressor.
Ahrens
Thorben
T
Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, J5, 68159 Mannheim, Germany.
Deuschle
Michael
M
Krumm
Bertram
B
van der Pompe
Gita
G
den Boer
Johan A
JA
Lederbogen
Florian
F
D000324:Adrenocorticotropic Hormone / Q000097:blood; D001143:Arousal / Q000502:physiology*; D015331:Cohort Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D004562:Electrocardiography; D004837:Epinephrine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D012008:Recurrence; D012016:Reference Values; D013315:Stress, Psychological / Q000150:complications*; D013564:Sympathetic Nervous System / Q000503:physiopathology*
D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone; D009638:Norepinephrine; D004837:Epinephrine