Free Cortisol Levels after Awakening: A Reliable Biological Marker for the Assessment of Adrenocortical Activity
Abstract
In three independent studies, free cortisol levels after morning awakening were repeatedly measured in children, adults and elderly subjects (total n=152). Cortisol was assessed by sampling saliva at 10 or 15 minute intervals for 30-60 minutes, beginning at the time of awakening for two days (Study 1 and 2) or one (Study 3) day, respectively. In all three studies, free cortisol levels increased by 50-75% within the first 30 minutes after awakening in both sexes on all days. Premenopausal women consistently showed a stronger increase with a delayed peak after awakening compared to men on all days. In Study 2, there was a tendency for lower early morning free cortisol levels for women taking oral contraceptives (p=.10). Stability of the area under the curve (AUC) of the early morning free cortisol levels over the three (Study 1 and 2) or two (Study 3) days ranged between r=.39 and r=.67 (p<.001). Neither age, weight, nor smoking showed an effect on baseline or peak cortisol levels. Sleep duration, time of awakening and alcohol consumption also appeared to be unrelated to early morning free cortisol levels. From these data we conclude that in contrast to single assessments at fixed times, early morning cortisol levels can be a reliable biological marker for the individual's adrenocortical activity when measured repeatedly with strict reference to the time of awakening.
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The CAR is a pronounced increase in cortisol level (on average 50-60%) that peaks approximately 30 to 40 min after waking.
“the cortisol awakening response (CAR) – the pronounced (on average, 50–60%) increase in cortisol level that peaks approximately 30 to 40 min after waking (Pruessner et al. 1997).”
From The cortisol awakening response predicts major depression: predictive stability over a 4-year follow-up and effect of depression history (2013) · cites this paper as Pruessner et al. 1997
Only two samples were collected to define the CAR (0 and 40 min after waking), rather than the original approach of samples taken every 10-15 min for 1 h after waking.
“First, due to concerns about feasibility with 17-year-olds and participant burden, only two samples were collected to define the CAR (0 and 40 min after waking), rather than the original approach, which relied on samples taken every 10–15 min for 1 h after waking (Pruessner et al. 1997).”
From The cortisol awakening response predicts major depression: predictive stability over a 4-year follow-up and effect of depression history (2013) · cites this paper as Pruessner et al. 1997
The cortisol awakening response is increased by work stressors.
“The cortisol awakening response is a reliable marker of HPA axis activity which has been found to be increased by work stressors (Pruessner et al. 1997; Kunz-Ebrecht et al. 2004) and in individuals at high risk of depression (Mannie et al. 2007).”
From Prebiotic intake reduces the waking cortisol response and alters emotional bias in healthy volunteers (2015) · cites this paper as Pruessner et al. 1997
The cortisol awakening response is a reliable marker of HPA axis activity.
“The cortisol awakening response is a reliable marker of HPA axis activity which has been found to be increased by work stressors (Pruessner et al. 1997; Kunz-Ebrecht et al. 2004) and in individuals at high risk of depression (Mannie et al. 2007).”
From Prebiotic intake reduces the waking cortisol response and alters emotional bias in healthy volunteers (2015) · cites this paper as Pruessner et al. 1997
Cortisol concentrations increase sharply right after waking, reach a maximum around 30 to 45 minutes later, and then gradually fall over the rest of the day.
“Cortisol levels rise steeply immediately after awakening in the morning and peak approximately 30-45 minutes thereafter; from there, they slowly decrease throughout the day.”
From Psychosocial functioning and the cortisol awakening response: meta-analysis, P-curve analysis, and evaluation of the evidential value in existing studies (2017) · cites this paper as Pruessner, 1997
Cortisol diurnal rhythms vary according to individual sleep-wake schedules, being high upon waking, peaking approximately 30-40 minutes after waking, and declining to a nadir around bedtime.
“Cortisol diurnal rhythms vary according to individual sleep-wake schedules, being high upon waking, increasing to peak levels approximately 30-40 minutes after waking, and declining to a nadir around bedtime (Kirschbaum and Helhammer, 2000; Pruessner et al., 1997; Wilhelm et al., 2007).”
From Prospective prediction of major depressive disorder from cortisol awakening responses in adolescence (2010) · cites this paper as Pruessner et al., 1997
The CAR protocol used in this study was less intensive and thus less precise than the original CAR protocol, in which cortisol levels were obtained every 10 to 15 minutes after awakening.
“It is important to note that this study was originally designed to examine multiple elements of the cortisol diurnal rhythm across the day, in addition to the CAR. As a result, in order to reduce participant burden, the protocol for the CAR is less intensive, and thus less precise, than the original CAR protocol, in which cortisol levels were obtained every 10 to 15 minutes after awakening (Pruess”
From Prospective prediction of major depressive disorder from cortisol awakening responses in adolescence (2010) · cites this paper as Pruessner et al., 1997
Awakenings and sleep offset are accompanied by cortisol stimulation.
“awakenings and sleep offset are accompanied by cortisol stimulation”
From Impact of Sleep and Its Disturbances on Hypothalamo-Pituitary-Adrenal Axis Activity (2010) · cites this paper as [39]
Cites
Statistical Power Analysis for the Behavioral Sciences (2nd ed.).
Lachenbruch, P. A., & Cohen, J. (1989) · Journal of the American Statistical Association · doi:10.2307/2290095 · Cited by 37,385 · see citing works
Salivary Cortisol in Psychobiological Research: An Overview
Kirschbaum, C., & Hellhammer, D. H. (2008) · Neuropsychobiology · doi:10.1159/000118611 · Cited by 1,532 · see citing works
Self-citationGray, A., Feldman, H. A., McKinlay, J. B., & Longcope, C. (1991) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-73-5-1016 · Cited by 1,104 · see citing works
Dressendörfer, R. A., Kirschbaum, C., Rohde, W., Stahl, F., & Strasburger, C. J. (1992) · The Journal of Steroid Biochemistry and Molecular Biology · doi:10.1016/0960-0760(92)90294-s · Cited by 882 · see citing works
Self-citationOelkers, W. (1996) · New England Journal of Medicine · doi:10.1056/nejm199610173351607 · Cited by 737 · see citing works
Consistent sex differences in cortisol responses to psychological stress.
Kirschbaum, C., Wüst, S., & Hellhammer, D. (1992) · Psychosomatic Medicine · doi:10.1097/00006842-199211000-00004 · Cited by 730 · see citing works
Self-citationSalivary cortisol measurement: a practical approach to assess pituitary-adrenal function.
LAUDAT, M. H., CERDAS, S., FOURNIER, C., GUIBAN, D., GUILHAUME, B., & LUTON, J. P. (1988) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-66-2-343 · Cited by 393 · see citing works
Hormones in saliva: mode of entry and consequent implications for clinical interpretation
Vining, R. F., McGinley, R. A., & Symons, R. G. (1983) · Clinical Chemistry · doi:10.1093/clinchem/29.10.1752 · Cited by 341 · see citing works
Sleep disruption alters nocturnal ACTH and cortisol secretory patterns
Späth-Schwalbe, E., Gofferje, M., Kern, W., Born, J., & Fehm, H. L. (1991) · Biological Psychiatry · doi:10.1016/0006-3223(91)90093-2 · Cited by 266 · see citing works
Heuser, I. J. E., Gotthardt, U., Schweiger, U., Schmider, J., Lammers, C.-H., Dettling, M., & Holsboer, F. (1994) · Neurobiology of Aging · doi:10.1016/0197-4580(94)90117-1 · Cited by 240 · see citing works
Kirschbaum, C., Pirke, K., & Hellhammer, D. H. (1995) · Psychoneuroendocrinology · doi:10.1016/0306-4530(94)00078-o · Cited by 215 · see citing works
Self-citationAdrenal status assessed by direct radioimmunoassay of cortisol in whole saliva or parotid saliva.
Walker, R. F., Riad-Fahmy, D., & Read, G. F. (1978) · Clinical Chemistry · doi:10.1093/clinchem/24.9.1460 · Cited by 186 · see citing works
Kirschbaum, C., Schommer, N., Federenko, I. S., Gaab, J., Neumann, O., Oellers, M., Rohleder, N., Untiedt, A., Hanker, J. P., Pirke, K., et al. (1996) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.81.10.8855815 · Cited by 172 · see citing works
Self-citationCortisol and behavior: 2. Application of a Latent state-trait model to salivary cortisol
Kirschbaum, C., Steyer, R., Eid, M., Patalla, U., Schwenkmezger, P., & Hellhammer, D. H. (1990) · Psychoneuroendocrinology · doi:10.1016/0306-4530(90)90080-s · Cited by 128 · see citing works
Self-citationSubstrate and hormonal responses to exercise in women using oral contraceptives
Bonen, A., Haynes, F. W., & Graham, T. E. (1991) · Journal of Applied Physiology · doi:10.1152/jappl.1991.70.5.1917 · Cited by 126 · see citing works
Multifactorial control of the 24-hour secretory profiles of pituitary hormones
Van Cauter, E., & Refetoff, S. (1985) · Journal of Endocrinological Investigation · doi:10.1007/bf03348519 · Cited by 104 · see citing works
Coste, J., Strauch, G., Letrait, M., & BERTAGNA, X. Y. (1994) · British Journal of Clinical Pharmacology · doi:10.1111/j.1365-2125.1994.tb04386.x · Cited by 76 · see citing works
Cauter, E. V., Polonsky, K. S., Blackman, J. D., Roland, D., Sturis, J., Byrne, M. M., & Scheen, A. J. (1994) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.79.6.7989487 · Cited by 69 · see citing works
SALIVARY CORTISOL LEVELS IN TRUE AND APPARENT HYPERCORTISOLISM
Evans, P., Peters, J. R., Dyas, J., WALKER, R. F., Riad-Fahmy, D., & Hall, R. (1984) · Clinical Endocrinology · doi:10.1111/j.1365-2265.1984.tb00121.x · Cited by 54 · see citing works
Spath-Schwalbe, E. (1992) · Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.75.6.1431 · Cited by 39 · see citing works
Schulz, P., & Knabe, R. (1994) · Medical Hypotheses · doi:10.1016/0306-9877(94)90038-8 · Cited by 20 · see citing works
CANADIAN CROSS-CULTURAL COMPARISON OF THE HIGH-RISK PREGNANCY STRESS SCALE
Goulet, C., Polomeno, V., & Harel, F. (1996) · Stress Medicine · doi:10.1002/(sici)1099-1700(199607)12:3 · Cited by 16 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Salivary cortisol as a biomarker in stress research
Hellhammer, D. H., Wüst, S., & Kudielka, B. M. (2009) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2008.10.026 · Cited by 1,925 · see citing works
Self-citationKirschbaum, C., Kudielka, B. M., Gaab, J., Schommer, N. C., & Hellhammer, D. H. (1999) · Psychosomatic Medicine · doi:10.1097/00006842-199903000-00006 · Cited by 1,890 · see citing works
Self-citationThe effects of sex and hormonal status on the physiological response to acute psychosocial stress
Kajantie, E., & Phillips, D. I. W. (2006) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2005.07.002 · Cited by 1,035 · see citing works
Cortisol awakening response and psychosocial factors: a systematic review and meta-analysis
Chida, Y., & Steptoe, A. (2009) · Biological Psychology · doi:10.1016/j.biopsycho.2008.10.004 · Cited by 1,032 · see citing works
Stress and Health: A Review of Psychobiological Processes
O'Connor, D. B., Thayer, J. F., & Vedhara, K. (2021) · Annual Review of Psychology · doi:10.1146/annurev-psych-062520-122331 · Cited by 948 · see citing works
Melamed, S., Shirom, A., Toker, S., Berliner, S., & Shapira, I. (2006) · Psychological Bulletin · doi:10.1037/0033-2909.132.3.327 · Cited by 943 · see citing works
Adam, E. K., Quinn, M. E., Tavernier, R., McQuillan, M. T., Dahlke, K. A., & Gilbert, K. E. (2017) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2017.05.018 · Cited by 905 · see citing works
The awakening cortisol response: methodological issues and significance
Clow, A., Thorn, L., Evans, P., & Hucklebridge, F. (2004) · Stress · doi:10.1080/10253890410001667205 · Cited by 856 · see citing works
Biological and psychological markers of stress in humans: Focus on the Trier Social Stress Test
Allen, A. P., Kennedy, P. J., Cryan, J. F., Dinan, T. G., & Clarke, G. (2014) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2013.11.005 · Cited by 734 · see citing works
Chronic stress, cognitive functioning and mental health
Marin, M.-F., Lord, C., Andrews, J., Juster, R.-P., Sindi, S., Arsenault-Lapierre, G., Fiocco, A. J., & Lupien, S. J. (2011) · Neurobiology of Learning and Memory · doi:10.1016/j.nlm.2011.02.016 · Cited by 654 · see citing works
The cortisol awakening response: More than a measure of HPA axis function
Clow, A., Hucklebridge, F., Stalder, T., Evans, P., & Thorn, L. (2010) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2009.12.011 · Cited by 635 · see citing works
Hellhammer, J., Fries, E., Schweisthal, O. W., Schlotz, W., Stone, A. A., & Hagemann, D. (2007) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2006.10.005 · Cited by 540 · see citing works
Schmidt, K., Cowen, P. J., Harmer, C. J., Tzortzis, G., Errington, S., & Burnet, P. W. J. (2015) · Psychopharmacology · doi:10.1007/s00213-014-3810-0 · Cited by 522 · see citing works
ROHLEDER, N., NATER, U. M., WOLF, J. M., EHLERT, U., & KIRSCHBAUM, C. (2004) · Annals of the New York Academy of Sciences · doi:10.1196/annals.1314.033 · Cited by 520 · see citing works
Self-citationKunz-Ebrecht, S. R., Kirschbaum, C., Marmot, M., & Steptoe, A. (2004) · Psychoneuroendocrinology · doi:10.1016/s0306-4530(03)00072-6 · Cited by 466 · see citing works
Self-citationIs the cortisol awakening rise a response to awakening?
Wilhelm, I., Born, J., Kudielka, B. M., Schlotz, W., & Wüst, S. (2007) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2007.01.008 · Cited by 454 · see citing works
Van den Bergh, B. R. H., Van Calster, B., Smits, T., Van Huffel, S., & Lagae, L. (2008) · Neuropsychopharmacology · doi:10.1038/sj.npp.1301450 · Cited by 434 · see citing works
Schlotz, W., Hellhammer, J., Schulz, P., & Stone, A. A. (2004) · Psychosomatic Medicine · doi:10.1097/01.psy.0000116715.78238.56 · Cited by 418 · see citing works
Impact of Sleep and Its Disturbances on Hypothalamo-Pituitary-Adrenal Axis Activity
Balbo, M., Leproult, R., & Van Cauter, E. (2010) · International Journal of Endocrinology · doi:10.1155/2010/759234 · Cited by 408 · see citing works
“In addition, it is detectable independently of the time and the mode of awakening (naturally or induced) [39], both in long and short sleepers [40].”
BackgroundRohleder, N., Joksimovic, L., Wolf, J. M., & Kirschbaum, C. (2004) · Biological Psychiatry · doi:10.1016/j.biopsych.2003.11.018 · Cited by 393 · see citing works
Self-citationvon Dawans, B., Kirschbaum, C., & Heinrichs, M. (2011) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2010.08.004 · Cited by 387 · see citing works
Self-citationSchmidt-Reinwald, A., Pruessner, J. C., Hellhammer, D. H., Federenko, I., Rohleder, N., Schürmeyer, T. H., & Kirschbaum, C. (1999) · Life Sciences · doi:10.1016/s0024-3205(99)00103-4 · Cited by 367 · see citing works
Self-citationJob strain and anger expression predict early morning elevations in salivary cortisol
Steptoe, A., Cropley, M., Griffith, J., & Kirschbaum, C. (2000) · Psychosomatic Medicine · doi:10.1097/00006842-200003000-00022 · Cited by 365 · see citing works
Self-citationPsychobiological mechanisms of socioeconomic differences in health
Kristenson, M., Eriksen, H. R., Sluiter, J. K., Starke, D., & Ursin, H. (2004) · Social Science & Medicine · doi:10.1016/s0277-9536(03)00353-8 · Cited by 351 · see citing works
Gender differences in irritable bowel syndrome
Chang, L., & Heitkemper, M. M. (2002) · Gastroenterology · doi:10.1053/gast.2002.36603 · Cited by 351 · see citing works
Prospective prediction of major depressive disorder from cortisol awakening responses in adolescence
Adam, E. K., Doane, L. D., Zinbarg, R. E., Mineka, S., Craske, M. G., & Griffith, J. W. (2010) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2009.12.007 · Cited by 315 · see citing works
Pruessner, M., Cullen, A. E., Aas, M., & Walker, E. F. (2017) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2016.12.013 · Cited by 315 · see citing works
Mindfulness training affects attention—Or is it attentional effort?
Jensen, C. G., Vangkilde, S., Frokjaer, V., & Hasselbalch, S. G. (2012) · Journal of Experimental Psychology: General · doi:10.1037/a0024931 · Cited by 284 · see citing works
Altered cortisol awakening response in posttraumatic stress disorder
Wessa, M., Rohleder, N., Kirschbaum, C., & Flor, H. (2006) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2005.06.010 · Cited by 282 · see citing works
Self-citationHypothalamic-pituitary-adrenal axis dysfunction in chronic fatigue syndrome
Papadopoulos, A. S., & Cleare, A. J. (2012) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2011.153 · Cited by 280 · see citing works
The effects of physical activity on cortisol and sleep: A systematic review and meta-analysis.
De Nys, L., Anderson, K., Ofosu, E. F., Ryde, G. C., Connelly, J., & Whittaker, A. C. (2022) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2022.105843 · Cited by 279 · see citing works
Aging and the HPA axis: Stress and resilience in older adults
Gaffey, A. E., Bergeman, C. S., Clark, L. A., & Wirth, M. M. (2016) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2016.05.036 · Cited by 273 · see citing works
Intraindividual stability of hair cortisol concentrations
Stalder, T., Steudte, S., Miller, R., Skoluda, N., Dettenborn, L., & Kirschbaum, C. (2012) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2011.08.007 · Cited by 271 · see citing works
Self-citationGlucocorticoid Release and Memory Consolidation in Men and Women
Andreano, J. M., & Cahill, L. (2006) · Psychological Science · doi:10.1111/j.1467-9280.2006.01729.x · Cited by 270 · see citing works
Salivary cortisol response to awakening in chronic fatigue syndrome
Roberts, A. D. L., Wessely, S., Chalder, T., Papadopoulos, A., & Cleare, A. J. (2004) · British Journal of Psychiatry · doi:10.1192/bjp.184.2.136 · Cited by 265 · see citing works
Positive affect and psychobiological processes
Dockray, S., & Steptoe, A. (2010) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2010.01.006 · Cited by 263 · see citing works
Engert, V., Vogel, S., Efanov, S. I., Duchesne, A., Corbo, V., Ali, N., & Pruessner, J. C. (2011) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2011.02.018 · Cited by 232 · see citing works
Self-citationCortisol as a marker for improvement in mindfulness-based stress reduction
Matousek, R. H., Dobkin, P. L., & Pruessner, J. (2010) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2009.06.004 · Cited by 233 · see citing works
Self-citationKumari, M., Badrick, E., Ferrie, J., Perski, A., Marmot, M., & Chandola, T. (2009) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2009-0555 · Cited by 229 · see citing works
Mantella, R. C., Butters, M. A., Amico, J. A., Mazumdar, S., Rollman, B. L., Begley, A. E., Reynolds, C. F., & Lenze, E. J. (2008) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2008.03.002 · Cited by 222 · see citing works
Halligan, S. L., Herbert, J., Goodyer, I., & Murray, L. (2007) · Biological Psychiatry · doi:10.1016/j.biopsych.2006.09.011 · Cited by 217 · see citing works
Vrshek-Schallhorn, S., Doane, L. D., Mineka, S., Zinbarg, R. E., Craske, M. G., & Adam, E. K. (2013) · Psychological Medicine · doi:10.1017/s0033291712001213 · Cited by 220 · see citing works
Circadian regulation of cortisol after hippocampal damage in humans
Buchanan, T. W., Kern, S., Allen, J. S., Tranel, D., & Kirschbaum, C. (2004) · Biological Psychiatry · doi:10.1016/j.biopsych.2004.08.014 · Cited by 206 · see citing works
Highly neurotic never-depressed students have negative biases in information processing
CHAN, S. W. Y., GOODWIN, G. M., & HARMER, C. J. (2007) · Psychological Medicine · doi:10.1017/s0033291707000669 · Cited by 195 · see citing works
Knowles, S. R., Nelson, E. A., & Palombo, E. A. (2008) · Biological Psychology · doi:10.1016/j.biopsycho.2007.09.010 · Cited by 192 · see citing works
Increased Waking Salivary Cortisol Levels in Young People at Familial Risk of Depression
Mannie, Z. N., Harmer, C. J., & Cowen, P. J. (2007) · American Journal of Psychiatry · doi:10.1176/ajp.2007.164.4.617 · Cited by 192 · see citing works
Not fade away: the HPA axis and depression
Cowen, P. J. (2010) · Psychological Medicine · doi:10.1017/s0033291709005558 · Cited by 191 · see citing works
The cortisol awakening response and major depression: examining the evidence
Dedovic, K., & Ngiam, J. (2015) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s62289 · Cited by 191 · see citing works
Sánchez, M. M., Noble, P. M., Lyon, C. K., Plotsky, P. M., Davis, M., Nemeroff, C. B., & Winslow, J. T. (2005) · Biological Psychiatry · doi:10.1016/j.biopsych.2004.11.032 · Cited by 178 · see citing works
Free cortisol awakening responses are influenced by awakening time
Federenko, I., Wüst, S., Hellhammer, D. H., Dechoux, R., Kumsta, R., & Kirschbaum, C. (2004) · Psychoneuroendocrinology · doi:10.1016/s0306-4530(03)00021-0 · Cited by 173 · see citing works
“Some studies did not observe a significant impact of time of awakening on the subsequent cortisol response (Pruessner et al., 1997; Wüst et al., 2000b).”
BackgroundInfluentialSelf-citationInfluence of mindfulness practice on cortisol and sleep in long-term and short-term meditators
Brand, S., Holsboer-Trachsler, E., Naranjo, J. R., & Schmidt, S. (2012) · Neuropsychobiology · doi:10.1159/000330362 · Cited by 169 · see citing works
Epigenetic modulation of glucocorticoid receptors in posttraumatic stress disorder
Labonté, B., Azoulay, N., Yerko, V, Turecki, G., & Brunet, A. (2014) · Translational Psychiatry · doi:10.1038/tp.2014.3 · Cited by 162 · see citing works
Quirin, M., Pruessner, J. C., & Kuhl, J. (2008) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2008.01.013 · Cited by 167 · see citing works
Self-citationDesign Decisions to Optimize Reliability of Daytime Cortisol Slopes in an Older Population
Kraemer, H. C., Giese-Davis, J., Yutsis, M., O'Hara, R., Neri, E., Gallagher-Thompson, D., Taylor, C. B., & Spiegel, D. (2006) · The American Journal of Geriatric Psychiatry · doi:10.1097/01.jgp.0000201816.26786.5b · Cited by 166 · see citing works
Christopher, M. S., Goerling, R. J., Rogers, B. S., Hunsinger, M., Baron, G., Bergman, A. L., & Zava, D. T. (2016) · Journal of Police and Criminal Psychology · doi:10.1007/s11896-015-9161-x · Cited by 170 · see citing works
Testosterone responsiveness to winning and losing experiences in female soccer players
Oliveira, T., Gouveia, M. J., & Oliveira, R. F. (2009) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2009.02.006 · Cited by 163 · see citing works
Increase in Concentration of Waking Salivary Cortisol in Recovered Patients With Depression
Bhagwagar, Z., Hafizi, S., & Cowen, P. J. (2003) · American Journal of Psychiatry · doi:10.1176/appi.ajp.160.10.1890 · Cited by 161 · see citing works
Dressle, R. J., Feige, B., Spiegelhalder, K., Schmucker, C., Benz, F., Mey, N. C., & Riemann, D. (2022) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2022.101588 · Cited by 161 · see citing works
Herbert, J., & Lucassen, P. J. (2016) · Frontiers in Neuroendocrinology · doi:10.1016/j.yfrne.2015.12.001 · Cited by 150 · see citing works
Is low cortisol release an indicator of positive health?
Lindfors, P., & Lundberg, U. (2002) · Stress and Health · doi:10.1002/smi.942 · Cited by 153 · see citing works
The cortisol awakening response is blunted in psychotherapy inpatients suffering from depression
Huber, T. J., Issa, K., Schik, G., & Wolf, O. T. (2006) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2006.03.005 · Cited by 152 · see citing works
Self-citationCurtis, K., Osadchuk, & Katz, J. (2011) · Journal of Pain Research · doi:10.2147/jpr.s22761 · Cited by 150 · see citing works
Morningness-eveningness, habitual sleep-wake variables and cortisol level
Randler, C., & Schaal, S. (2010) · Biological Psychology · doi:10.1016/j.biopsycho.2010.04.006 · Cited by 150 · see citing works
Fibromyalgia syndrome is associated with hypocortisolism
Riva, R., Mork, P. J., Westgaard, R. H., Rø, M., & Lundberg, U. (2010) · International Journal of Behavioral Medicine · doi:10.1007/s12529-010-9097-6 · Cited by 143 · see citing works
Fischer, S., Wilhelm, I., & Born, J. (2007) · Journal of Cognitive Neuroscience · doi:10.1162/jocn.2007.19.2.214 · Cited by 142 · see citing works
Blomqvist, M., Holmberg, K., Lindblad, F., Fernell, E., Ek, U., & Dahllöf, G. (2007) · European Journal of Oral Sciences · doi:10.1111/j.1600-0722.2007.00423.x · Cited by 139 · see citing works
Kudielka, B. M., Schmidt-Reinwald, A. K., Hellhammer, D. H., & Kirschbaum, C. (1999) · Neuroendocrinology · doi:10.1159/000054504 · Cited by 135 · see citing works
Self-citationA review of selected candidate endophenotypes for depression
Goldstein, B. L., & Klein, D. N. (2014) · Clinical Psychology Review · doi:10.1016/j.cpr.2014.06.003 · Cited by 128 · see citing works
Behavioral problems in dementia patients and salivary cortisol patterns in caregivers
de Vugt, M. E., Nicolson, N. A., Aalten, P., Lousberg, R., Jolle, J., & Verhey, F. R. J. (2005) · The Journal of Neuropsychiatry and Clinical Neurosciences · doi:10.1176/jnp.17.2.201 · Cited by 136 · see citing works
Cortisol secretion in depressed, and at-risk adults
Dienes, K. A., Hazel, N. A., & Hammen, C. L. (2013) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2012.09.019 · Cited by 128 · see citing works
Inflammation and cortisol response in coronary artery disease
Nijm, J., & Jonasson, L. (2009) · Annals of Medicine · doi:10.1080/07853890802508934 · Cited by 128 · see citing works
Bhagwagar, Z., & Cowen, P. J. (2008) · Psychological Medicine · doi:10.1017/s0033291707001250 · Cited by 124 · see citing works
No morning cortisol response in patients with severe global amnesia
Wolf, O. T., Fujiwara, E., Luwinski, G., Kirschbaum, C., & Markowitsch, H. J. (2005) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2004.05.001 · Cited by 112 · see citing works
Self-citationMommersteeg, P. M. C., Heijnen, C. J., Verbraak, M. J. P. M., & van Doornen, L. J. P. (2006) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2005.07.003 · Cited by 111 · see citing works
Cortisol awakening response in patients with psychosis: systematic review and meta-analysis
Berger, M., Kraeuter, A. K., Romanik, D., Malouf, P., Amminger, G. P., & Sarnyai, Z. (2016) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2016.05.027 · Cited by 109 · see citing works
Plant, D. T., Pawlby, S., Sharp, D., Zunszain, P. A., & Pariante, C. M. (2016) · Translational Psychiatry · doi:10.1038/tp.2015.155 · Cited by 108 · see citing works
Change in stress levels following mindfulness-based stress reduction in a therapeutic community
Marcus, M. T., Fine, P. M., Moeller, F. G., Khan, M. M., Pitts, K., Swank, P. R., & Liehr, P. (2003) · Addictive Disorders & Their Treatment · doi:10.1097/00132576-200302030-00001 · Cited by 106 · see citing works
A systematic review of the effects of mindfulness interventions on cortisol
O’Leary, K., O’Neill, S., & Dockray, S. (2016) · Journal of Health Psychology · doi:10.1177/1359105315569095 · Cited by 103 · see citing works
White blood cells and cortisol after sleep deprivation and recovery sleep in humans
Heiser, P., Dickhaus, B., Schreiber, W., Clement, H. W., Hasse, C., Hennig, J., Remschmidt, H., Krieg, J. C., Wesemann, W., & Opper, C. (2000) · European Archives of Psychiatry and Clinical Neurosciences · doi:10.1007/pl00007534 · Cited by 105 · see citing works
Boggero, I. A., Hostinar, C. E., Haak, E. A., Murphy, M. L. M., & Segerstrom, S. C. (2017) · Biological Psychology · doi:10.1016/j.biopsycho.2017.08.058 · Cited by 97 · see citing works
Matousek, R. H., Pruessner, J. C., & Dobkin, P. L. (2011) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2010.10.005 · Cited by 93 · see citing works
Self-citationState variation in the cortisol awakening response
Law, R., Hucklebridge, F., Thorn, L., Evans, P., & Clow, A. (2013) · Stress · doi:10.3109/10253890.2013.817552 · Cited by 89 · see citing works
Allaway, H. C. M., Southmayd, E. A., & De Souza, M. J. (2016) · Hormone Molecular Biology and Clinical Investigation · doi:10.1515/hmbci-2015-0053 · Cited by 89 · see citing works
Reductions in cortisol associated with primary care brief mindfulness program for veterans with PTSD
Bergen-Cico, D., Possemato, K., & Pigeon, W. (2014) · Medical Care · doi:10.1097/mlr.0000000000000224 · Cited by 84 · see citing works
Heuschkel, K., & Kuypers, K. P. C. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00224 · Cited by 86 · see citing works
“The inadequate HPA responsivity in MDD is further marked by a diminished cortisol awakening response (CAR), as opposed to healthy people who demonstrate steeply elevated cortisol levels within the first 30 min upon awakening (30, 31).”
BackgroundSmyth, N., Clow, A., Thorn, L., Hucklebridge, F., & Evans, P. (2013) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2012.12.013 · Cited by 85 · see citing works
The Diurnal Cortisol Cycle in Delinquent Male Adolescents and Normal Controls
Popma, A., Doreleijers, T. A. H., Jansen, L. M. C., Van Goozen, S. H. M., Van Engeland, H., & Vermeiren, R. (2007) · Neuropsychopharmacology · doi:10.1038/sj.npp.1301289 · Cited by 85 · see citing works
Champaneri, S., Xu, X., Carnethon, M. R., Bertoni, A. G., Seeman, T., Roux, A. D., & Golden, S. H. (2012) · Metabolism · doi:10.1016/j.metabol.2011.11.006 · Cited by 85 · see citing works
White, D., De Klerk, S., Woods, W., Gondalia, S., Noonan, C., & Scholey, A. (2016) · Nutrients · doi:10.3390/nu8010053 · Cited by 85 · see citing works
Edwards, S., Hucklebridge, F., Clow, A., & Evans, P. (2003) · Psychosomatic Medicine · doi:10.1097/01.psy.0000033123.70631.8e · Cited by 79 · see citing works
The Effect of Therapeutic Touch on Behavioral Symptoms and Cortisol in Persons with Dementia
Woods, D. L., Beck, C., & Sinha, K. (2009) · Forschende Komplementärmedizin / Research in Complementary Medicine · doi:10.1159/000220479 · Cited by 70 · see citing works
Øines, E., Murison, R., Mrdalj, J., Grønli, J., & Milde, A. M. (2012) · Physiology & Behavior · doi:10.1016/j.physbeh.2011.11.024 · Cited by 66 · see citing works
Höhn, C., Schmid, S. R., Plamberger, C. P., Bothe, K., Angerer, M., Gruber, G., Pletzer, B., & Hoedlmoser, K. (2021) · Clocks & Sleep · doi:10.3390/clockssleep3010005 · Cited by 61 · see citing works
“, cortisol awakening response (CAR)) [21].”
Expensive egos: narcissistic males have higher cortisol.
Reinhard, D. A., Konrath, S. H., Lopez, W. D., & Cameron, H. G. (2012) · PLoS ONE · doi:10.1371/journal.pone.0030858 · Cited by 61 · see citing works
Identification of biopsychological trait markers in functional neurological disorders
Weber, S., Bühler, J., Vanini, G., Loukas, S., Bruckmaier, R., & Aybek, S. (2023) · Brain · doi:10.1093/brain/awac442 · Cited by 63 · see citing works
CortiWatch: Watch-Based Cortisol Tracker
Rice, P., Upasham, S., Jagannath, B., Manuel, R., Pali, M., & Prasad, S. (2019) · Future Science OA · doi:10.2144/fsoa-2019-0061 · Cited by 63 · see citing works
O'Connor, D. B., Branley-Bell, D., Green, J. A., Ferguson, E., O'Carroll, R. E., & O'Connor, R. C. (2020) · Journal of Abnormal Psychology · doi:10.1037/abn0000482 · Cited by 60 · see citing works
Pruessner, M., Vracotas, N., Joober, R., Pruessner, J. C., & Malla, A. K. (2013) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2012.06.002 · Cited by 58 · see citing works
Self-citationHardeveld, F., Spijker, J., Vreeburg, S. A., Graaf, R. D., Hendriks, S. M., Licht, C. M. M., Nolen, W. A., Penninx, B. W. J. H., & Beekman, A. T. F. (2014) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2014.07.027 · Cited by 58 · see citing works
Engel, S., Laufer, S., Miller, R., Niemeyer, H., Knaevelsrud, C., & Schumacher, S. (2019) · Frontiers in Neuroendocrinology · doi:10.1016/j.yfrne.2019.100775 · Cited by 50 · see citing works
- Authors
- Pruessner, J. C., Wolf, O. T., Hellhammer, D. H., Buske-Kirschbaum, A., von Auer, K., Jobst, S., Kaspers, F., & Kirschbaum, C.
- Affiliations
- Universität Trier (DE)
- Corresponding author
- Kirschbaum, C.
- Venue
- Life Sciences
- Publisher
- Elsevier BV
- Published
- 1997-11
- Volume
- 61
- Issue
- 26
- Pages
- 2539-2549
- ISSN
- 0024-3205 (ISSN-L)
- OpenAlex
- W2057881388
- Cited by
- 1,450
- References
- 22
- Citations by year
- 2026: 31 · 2025: 37 · 2024: 42 · 2023: 50 · 2022: 56 · 2021: 71 · 2020: 91 · 2019: 67 · 2018: 63 · 2017: 69 · 2016: 93 · 2015: 73 · 2014: 92 · 2013: 80 · 2012: 72
- FWCI
- 4.02
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Life Sciences (publishedVersion)
- PubMed (publishedVersion)
- KOPS (University of Konstanz) (submittedVersion)
- Topics
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Keywords
- free cortisol, early morning awakening, adrenocortical function, salivary cortisol, biomarkers, sex differences, premenopausal women, oral contraceptives, diurnal cortisol rhythm, measurement reliability
- MeSH terms
- Adrenal Cortex, Adult, Aged, Aging, Child, Circadian Rhythm, Contraceptives, Oral, Female, Humans, Hydrocortisone, Kinetics, Male, Saliva, Sleep, Smoking, Wakefulness, Biomarkers, Premenopause
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