Cortisol trajectory, melancholia, and response to electroconvulsive therapy

被引:12
|
作者
Mickey, Brian J. [1 ,2 ]
Ginsburg, Yarden [2 ]
Sitzmann, Adam F. [2 ]
Grayhack, Clara [2 ]
Sen, Srijan [2 ]
Kirschbaum, Clemens [3 ]
Maixner, Daniel F. [2 ]
Abelson, James L. [2 ]
机构
[1] Univ Utah, Sch Med, Dept Psychiat, Salt Lake City, UT 84112 USA
[2] Univ Michigan, Sch Med, Dept Psychiat, Ann Arbor, MI USA
[3] Tech Univ Dresden, Dept Psychol, Dresden, Germany
关键词
Depression; Cortisol; Electroconvulsive therapy; Biomarker; Melancholia; HAIR CORTISOL; CLINICAL PREDICTORS; HPA-AXIS; FREE T-4; DEPRESSION; METAANALYSIS; STRESS; DISORDER; PITUITARY;
D O I
10.1016/j.jpsychires.2018.05.007
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
While biomarkers have been used to define pathophysiological types and to optimize treatment in many areas of medicine, in psychiatry such biomarkers remain elusive. Based on previously described abnormalities of hypothalamic -pituitary-adrenal (HPA) axis function in severe forms of depression, we hypothesized that the temporal trajectory of basal cortisol levels would vary among individuals with depression due to heterogeneity in pathophysiology, and that cortisol trajectories that reflect elevated or increasing HPA activity would predict better response to electroconvulsive therapy (ECT). To test that hypothesis, we sampled scalp hair from 39 subjects with treatment-resistant depression just before ECT. Cortisol trajectory over the 12 weeks preceding ECT was reconstructed from cortisol concentrations in sequential hair segments. Cortisol trajectories varied widely between individuals, and exploratory analyses of clinical features revealed associations with melancholia and global severity. ECT non-responders showed a decreasing trajectory (mean change 25%, 95% CI = [-1%,-43%]) during the 8 weeks preceding ECT (group-by-time interaction, p = 0.004). The association between cortisol trajectory and subsequent ECT response was independent of clinical features. A classification algorithm showed that cortisol trajectory predicted ECT response with 80% accuracy, suggesting that this biomarker might be developed into a clinically useful test for ECT-responsive depression. In conclusion, cortisol trajectory mapped onto symptoms of melancholia and independently predicted response to ECT in this severely depressed sample. These findings deserve to be replicated in a larger sample. Cortisol trajectory holds promise as a reliable, noninvasive, inexpensive biomarker for psychiatric disorders.
引用
收藏
页码:46 / 53
页数:8
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