Hypothalamic–pituitary–adrenal axis activity in older persons with and without a depressive disorder. (January 2015)

• Record Type: Journal Article
• Authors: Rhebergen, D.; Korten, N.C.M.; Penninx, B.W.J.H.; Stek, M.L.; van der Mast, R.C.; Oude Voshaar, R.; Comijs, H.C.
• Is Part Of: Psychoneuroendocrinology. Volume 51(2015:Jan.)
• Page Start: 341
• Page End: 350
• Publication Date: 2015-01
• Subjects: Cortisol -- HPA-axis -- Depression -- Older persons; Psychoneuroendocrinology -- Periodicals; Endocrinology -- Periodicals; Neurology -- Periodicals; Psychiatry -- Periodicals; Neuropsychoendocrinologie -- Périodiques; 616.8
• DOI: 10.1016/j.psyneuen.2014.10.005
• Languages: English
• ISSNs: 0306-4530

Abstract

Highlights: Older, depressed persons have higher cortisol levels at awakening than non-depressed controls. The stress response system of older, depressed persons is less responsive. No U-shaped association between HPA-axis activity and depression was observed in older persons. Summary: Background: Altered functioning of the hypothalamic–pituitary–adrenal axis (HPA-axis) has been associated with depression, but findings have been inconsistent. Among older depressed persons, both hyperactivity and hypo-activity of the HPA-axis were demonstrated. However, most studies were population-based studies, with single cortisol measurements, lacking insight into diurnal patterns of HPA-axis functioning. We aim to provide insight into functioning of the HPA-axis, assessed by various salivary cortisol samples, in depressed older adults and non-depressed controls. Methods: Data were derived from the Netherlands Study of Depression in Older Persons. Cortisol levels of older persons without a lifetime diagnosis of depression and/or anxiety ( n = 109) were compared with older persons with a 6-month major depression diagnosis ( n = 311). ANCOVA analyses and random coefficient analysis on the four morning cortisol samples were performed. A possible U-shaped association between cortisol and depression status was examined. Results: Depressed older persons showed higher morning cortisol levels at awakening (T1) and a less dynamic awakening response compared to non-depressed older persons. Dexamethasone suppression did not differ across groups. No U-shaped association between HPA-axis activity and depression was observed. Conclusion: We demonstrated a hypercortisolemic state and a diminished ability to respond to the stress of awakening among depressed older persons. Previously it was shown, that hypercortisolemic states may indicate a lifelong biological vulnerability for depression. Our findings expand on previous literature by demonstrating that in older persons the HPA-axis may become less responsive to stress, culminating in a further dysregulation of the diurnal cortisol-rhythm, superimposed on – possibly lifelong – hypercortisolemic states.