Persistence of abnormal cortisol levels in elderly persons after recovery from major depression
Persistence of abnormal cortisol levels in elderly persons after recovery from major depression
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DOI：
10.1016/j.jpsychires.2008.10.011
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发表时间：
2009-05-01
影响因子：
4.8
通讯作者：
Ancelin, Marie L.
中科院分区：
文献类型：
--
作者：
Beluche, Isabelle;Chaudieu, Isabelle;Ancelin, Marie L.
背景：皮质醇高分泌是急性临床抑郁症的特征，但在有终生抑郁史的完全康复、未经治疗的老年人中，人们对此知之甚少。本研究旨在研究一组没有抑郁症或接受抑郁症治疗的老年人皮质醇的日循环模式，根据患者是否有过抑郁或伴发抑郁伴焦虑的情况。方法：对162名社区老年人在应激日和非应激日(基础水平)进行皮质醇分泌评估。过去的抑郁症和焦虑症使用基于DSM-IV标准的标准化精神病学检查(迷你国际神经精神病学访谈)进行评估。结果：与抑郁症和焦虑症患者(8.6%)或对照组相比，无抗抑郁药的患者(6.8%的样本)表现为基础皮质醇高分泌。在暴露在压力环境中几个小时后，对照组显示皮质醇分泌持续增加，这在有抑郁症病史的人中没有观察到。有抑郁和焦虑病史的患者在基线时的皮质醇分泌与对照组相似，但对应激情况的反应增强；这种模式与单纯焦虑症患者的观察到的模式相似(16.7%)。结论：即使对抑郁症进行了有效的治疗，HPA反应仍然异常。抑郁和焦虑并存的病史会引起以焦虑为特征的变化。我们的发现表明，皮质醇异常可能是抑郁易感性的特征标志，也是区分抑郁和抑郁与共病焦虑的特征标志。(C)2008爱思唯尔有限公司。保留所有权利。
Background: Cortisol hypersecretion is characteristic of acute clinical depression, but little is known in fully recovered, non-treated elderly persons with a lifetime history of depression. This study was designed to examine patterns of diurnal cycle of cortisol in an elderly cohort without current depression or treatment for depression according to whether the person has or has not experienced a previous episode of depression or co-morbid depression with anxiety.Methods: Cortisol secretion was evaluated in 162 community-dwelling elderly on a stressful and a non-stressful day (basal level). Past depression and anxiety disorders were assessed using a standardized psychiatric examination based on DSM-IV criteria (the Mini International Neuropsychiatric Interview). Results: Antidepressant-free persons with a history of non-co-morbid major depression (6.8% of the sample) showed basal cortisol hypersecretion compared to those with depression and anxiety (8.6%) or controls. Several hours after exposure to a stressful situation, controls showed a sustained increase in cortisol secretion, which was not observed in persons with a history of depression. Persons with a history of depression with anxiety showed a similar cortisol secretion at baseline to controls but a heightened response to stressful situation; a pattern comparable to that observed in subjects with pure anxiety disorders (16.7%).Conclusion: An abnormal HPA response persists even after effective treatment for depression. A history of co-morbid depression and anxiety gives rise to changes characteristic of anxiety alone. Our findings suggest that cortisol abnormalities may be trait markers for vulnerability to depression and for the differentiation of depression and depression with co-morbid anxiety. (C) 2008 Elsevier Ltd. All rights reserved.