Major depression in late life is associated with both hypo- and hypercortisolemia
Major depression in late life is associated with both hypo- and hypercortisolemia
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DOI：
10.1016/j.biopsych.2006.11.033
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发表时间：
2007-09-01
影响因子：
10.6
通讯作者：
Hoogendijk, Witte J. G.
中科院分区：
文献类型：
--
作者：
Bremmer, Marijke A.;Deeg, Dorly J. H.;Hoogendijk, Witte J. G.
背景：在年轻人中，抑郁症与高皮质醇血症有关。然而，在老年抑郁症患者中，皮质醇水平既有低水平也有高水平。我们研究了老年人抑郁症和皮质醇之间存在 U 形关联的可能性，表明下丘脑 - 垂体 - 肾上腺轴的功能减退和过度活跃。我们还检查了这是否可能代表不同的抑郁症亚型。方法：这项基于人群的研究包括 1185 名 65 岁及以上的受试者。抑郁症的测量分为诊断水平（重度抑郁）和症状水平（阈下抑郁）。测定皮质醇（CORT）和皮质类固醇结合球蛋白（CBG）的血浆浓度。根据这些 (CORT/CBG)，计算出游离皮质醇指数 (FCI)。 结果：皮质醇与重度抑郁症之间的关联呈 U 形（B CORT = -9.50 [SE 3.85] p =.014；B CORT2 =.008 [SE.0031 p =.021）。低皮质醇抑郁症（低皮质醇三分位）与女性、关节疾病和吸烟有关。高皮质醇血症（上皮质醇三分位）抑郁症与年龄较大、男性、心血管疾病、非类固醇抗炎药使用和（临界显着）认知障碍有关。结论：在老年人中，皮质醇与重度抑郁症之间的关系呈 U 形。低皮质醇血症和高皮质醇血症抑郁症可能代表不同的抑郁症亚型，需要不同的临床治疗。
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 hypothalmic-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 globuline (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 CORT2 =.008 [SE.0031 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.