title: The cortisol level and its relationship with depression, stress and anxiety indices in chronic methamphetamine-dependent patients and normal individuals undergoing inguinal hernia surgery.
abstract: BACKGROUND
  Stimulants addition and abuse can cause some functional and morphological changes in the normal function of glands and hormones. Methamphetamine as an addictive stimulant drug affects the Hypothalamic- pituitary-adrenal (HPA) axis and consequently makes some changes in the psychological state of the drug users. The present study aims to examine the relationship between plasma levels of cortisol with depression, stress and anxiety symptoms in chronic methamphetamine-dependent patients and normal individuals who have undergone the inguinal hernia surgery.
  
  
  METHODS
  To meet the purpose of the study, 35 chronic methamphetamine-dependent patients in the active phase of drug abuse and 35 non-users (N=70) who were homogenized regarding the demographic features were purposefully selected from among the patients referred to undergo inguinal hernia surgery since March 15 to June 9, 2015. The participants were then divided into the control and experiment group. The changes in cortisol levels in plasma were measured using Radioimmunoassay (RIA) in three-time series including 0 (upon the induction of anesthesia), 12 and 24 hours after the surgery. Further, three behavioral indices of depression, anxiety and stress were measured using the Depression Anxiety Stress Scale 21 (DASS-21) and then the data were analyzed using t-test and Pearson Correlation coefficient.
  
  
  RESULTS
  The plasma level of cortisol in the chronic methamphetamine-dependent patients (experiment group) had a significant increase in 24 hours after surgery (p<0.05). This study showed that cortisol levels in chronic methamphetamine-dependent patients were significantly higher than non-dependent patients in response to alarming events such as inguinal surgery. Changes in cortisol levels were intensified due to a confrontation with the phenomenon of pain and anxiety. In addition, depression index was higher in the chronic methamphetaminedependent patients than that in the non-dependent patients. However, there was no significant relationship between the cortisol level and depression index (p=0.001).
  
  
  CONCLUSIONS
  The Hypothalamic-pituitary-adrenal (HPA) axis is considered as a key structure in the addiction to simulants, the reason which can explain the faster response of the chronic methamphetamine-dependent patients to the stressors such as surgery.
authors: PhD Student of Clinical Psychology, Department of Psychology, Faculty of Humanities, University of Science and Culture, Tehran, Iran. b.pirnia@usc.ac.ir.
authors: Bijan
authors: B
authors: Pirnia
authors: MA in Clinical Psychology, Department of Psychology, Islamic Azad University of Rudehen Branch, Tehran, Iran. givi_fatemeh@yahoo.com.
authors: Fatemeh
authors: F
authors: Givi
authors: Professor of Psychology, Department of Psychology, Faculty of Humanities, Shahed University, Tehran, Iran. rasolroshan@yahoo.com.
authors: Rasool
authors: R
authors: Roshan
authors: Internal Disease Specialist, Baharloo Hospital, Tehran, Iran. bijanpirnia@usc.ac.ir.
authors: Kambiz
authors: K
authors: Pirnia
authors: Assistant Professor of Psychology, Department of Psychology, University of Science and Culture, Tehran, Iran. solaymani64@yahoo.com.
authors: Ali Akbar
authors: AA
authors: Soleimani
keywords: Addiction; Cortisol; Depression; Hypothalamic; Methamphetamine; Radioimmunoassay; Surgery; adrenal; pituitary