Lower cortisol levels predict recurrence in remitted patients with recurrent depression: A 5.5 year prospective study
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Major Depressive Disorder (MDD) is a highly recurrent disease. Stress-responsive system dysfunction seems to persist after remission. In patients with more chronic and recurrent depressive episodes, state related HPA-axis dysregulation might be a risk factor for prospective recurrence. This study examines the predictive effect of cortisol on consecutive episodes in remitted recurrently depressed patients. Cortisol was assessed in saliva in remitted recurrently depressed patients (n=55) that were followed up prospectively for 5.5 years after remission. Recurrence was assessed using a well validated structured interview. Lower mean morning cortisol levels predicted earlier time to recurrence over 5.5 year after correction for residual symptoms (p=0.015). Residual symptoms and childhood trauma slightly confounded the association between cortisol and recurrence. Lower cortisol levels were associated with having experienced traumatic childhood life events (42.3% in patients with lower cortisol versus 19.2% in patients with higher cortisol). Our study provides further support for the predictive role over 5.5 year of HPA axis dysregulation, i.e. lower morning cortisol levels, of recurrence in recurrently depressed patients. Childhood trauma is associated to having lower cortisol levels. It might have long term consequences for dealing with stress and the HPA-axis.
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Longitudinal studies found that both higher and lower cortisol levels predicted recurrence of major depressive episodes in people with a history of major depressive disorder.
“Longitudinal studies have found that both enhanced and blunted cortisol levels predicted MDE recurrence amongst those with a prior history of MDD (72–74).”
From The Impact of Stress and Major Depressive Disorder on Hippocampal and Medial Prefrontal Cortex Morphology (2019) · cites this paper as [72]
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References 55 · Cited by 57
Research works printed but not linked: 2
- Bockting, C.L.H., Schene, A.H., Spinhoven, Ph., Koeter, M.W.J., Wouters, L.F., Huyser, J., Kamphuis, J.H., 2005. Preventing relapse/recurrence in recurrent depression using cognitive therapy. Journal of Consulting and Clinical Psychology 73, 647-657.
- Ten Doesschate, M.C., Bockting, C.L.H., Koeter, M.W.J., Schene, A.H., 2010. Predic- tion of recurrence in recurrent depression: a 5.5-year prospective study. Journal of Clinical Psychiatry 71, 984-991.
- Authors
- Bockting, C. L. H., Lok, A., Visser, I., Assies, J., Koeter, M. W., & Schene, A. H.
- Affiliations
- University of Groningen (NL)
- Amsterdam UMC Location University of Amsterdam (NL)
- Corresponding author
- Bockting, Claudi L.H.
- Venue
- Psychiatry Research
- Publisher
- Elsevier BV
- Published
- 2012-12
- Volume
- 200
- Issue
- 2-3
- Pages
- 281-287
- ISSN
- 0165-1781 (ISSN-L)
- OpenAlex
- W1993737273
- Cited by
- 57
- References
- 55
- Citations by year
- 2026: 1 · 2025: 3 · 2023: 1 · 2022: 3 · 2021: 3 · 2020: 2 · 2019: 3 · 2018: 5 · 2017: 3 · 2016: 5 · 2015: 7 · 2014: 11 · 2013: 9 · 2012: 1
- FWCI
- 3.71
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Psychiatry Research (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Funders
- ZonMw
- Fonds Psychische Gezondheid
- Topics
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- recurrent depression, major depressive disorder, cortisol, HPA axis dysregulation, remission, salivary cortisol, childhood trauma, residual symptoms, stress response
- MeSH terms
- Adult, Depressive Disorder, Female, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Longitudinal Studies, Male, Middle Aged, Pituitary-Adrenal System, Predictive Value of Tests, Prospective Studies, Recurrence, Risk Factors, Saliva, Severity of Illness Index
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