Hypothalamus-Pituitary-Adrenal Axis Hypersuppression Is Associated with Gastrointestinal Symptoms in Major Depression.
OBJECTIVE
Gastrointestinal symptoms and hypothalamus-pituitary-adrenal (HPA) axis dysfunction are frequently observed in patients with major depression. The primary aim of the study was to investigate the relationship between HPA-axis function and self-perceived functional gastrointestinal symptoms in major depression.


METHODS
Patients with major depression (n = 73) and controls representative of the general population (n = 146) underwent a weight adjusted very low dose dexamethasone suppression test (DST). Patients and controls completed the gastrointestinal symptom rating scale-iritable bowel syndrome (GSRS-IBS) and the hospital anxiety depression scale. Medical records of the patients were screened over a ten year period for functional gastrointestinal disorder and pain conditions.


RESULTS
Patients with high GSRS-IBS scores (above median) exhibited HPA-axis hypersuppression more often than controls (defined by the lowest 10% cutoff of the post-DST cortisol values among controls, adjusted OR 7.25, CI 1.97-26.7) whereas patients with low GSRS-IBS scores did not differ from controls concerning their post-DST cortisol values. Patients who had consulted primary care for functional gastrointestinal disorder (P = 0.039), lumbago (P = 0.006) and chronic multifocal pain (P = 0.057) also exhibited an increased frequency of hypersuppression.


CONCLUSIONS
HPA-axis hypersuppression is associated with functional gastrointestinal symptoms in patients with major depression.
Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden.
Pontus
P
Karling
Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden.|Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden.
Mikael
M
Wikgren
Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden.
Rolf
R
Adolfsson
Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden.
Karl-Fredrik
KF
Norrback
Depression; Dexamethasone; Hypocortisolism; Hypothalamo-hypophyseal system; Irritable bowel syndrome