The cortisol awakening response and major depression: examining the evidence
Open accessAbstract
A vast body of literature has revealed that dysregulation of the hypothalamic-pituitary-adrenal (HPA) stress axis is associated with etiology of major depressive disorder (MDD). There are many ways that the dysregulation of the HPA axis can be assessed: by sampling diurnal basal secretion and/or in response to a stress task, pharmacological challenge, and awakening. Here, we focus on the association between cortisol awakening response (CAR), as one index of HPA axis function, and MDD, given that the nature of this association is particularly unclear. Indeed, in the following selective review, we attempt to reconcile sometimes-divergent evidence of the role of CAR in the pathway to depression. We first examine association of CAR with psychological factors that have been linked with increased vulnerability to develop depression. Then, we summarize the findings regarding the CAR profile in those with current depression, and evaluate evidence for the role of CAR following depression resolution and continued vulnerability. Finally, we showcase longitudinal studies showing the role of CAR in predicting depression onset and recurrence. Overall, the studies reveal an important, but complex, association between CAR and vulnerability to depression.
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Dysregulated glucocorticoid secretion is associated with several debilitating health conditions, including major depressive disorder.
“Indeed, dysregulated glucocorticoid secretion is associated with several debilitating health conditions, including major depressive disorder54.”
From Circadian rhythm disruption and mental health (2020) · cites this paper as [54]
The Introduction (page not specified) states that HPA-axis dysregulation has been associated with major depressive disorder in children and adults, supporting the depression example. The paper focuses on depression and does not establish the broader claim that dysregulated glucocorticoid secretion is associated with several debilitating health conditions. (LLM, conf=0.86)
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Anderson, T., Vrshek‐Schallhorn, S., Adams, W. M., Goldfarb, A. H., & Wideman, L. (2023) · European Journal of Applied Physiology · doi:10.1007/s00421-023-05132-4 · Cited by 11 · see citing works
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Refsgaard, E., Schmedes, A., & Martiny, K. (2022) · Neuropsychobiology · doi:10.1159/000521234 · Cited by 11 · see citing works
Daily salivary cortisol profile: Insights from the Croatian Late Adolescence Stress Study (CLASS)
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- Authors
- Dedovic, K., & Ngiam, J.
- Affiliations
- University of California, Los Angeles (US)
- McGill University (CA)
- Corresponding author
- Dedovic, Katarina
- Venue
- Neuropsychiatric Disease and Treatment
- Publisher
- Informa UK Limited
- Published
- 2015-05
- Volume
- 11
- Pages
- 1181
- ISSN
- 1176-6328 (ISSN-L)
- 1178-2021
- PMC
- PMC4437603
- OpenAlex
- W1526681335
- Cited by
- 191
- References
- 98
- Citations by year
- 2026: 11 · 2025: 19 · 2024: 17 · 2023: 19 · 2022: 20 · 2021: 21 · 2020: 23 · 2019: 17 · 2018: 13 · 2017: 12 · 2016: 15 · 2015: 3
- FWCI
- 1.11
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Neuropsychiatric Disease and Treatment (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
- Topics
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- cortisol awakening response, major depressive disorder, hypothalamic-pituitary-adrenal axis, HPA axis dysregulation, depression vulnerability, depression recurrence, diurnal cortisol rhythm, stress response
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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