Salivary cortisol and dehydroepiandrosterone-sulfate (DHEA-S) in recurrent major depression: Comparison with matched healthy controls

Introduction

Chronic episodes (> 2 years of duration) of major depressive disorder may be associated with hypothalamus–pituitary–adrenal (HPA) axis dysfunction. In particular, abnormalities of the adrenal steroids cortisol and dehydroepiandrosterone-sulfate (DHEA-S) in patients in the remitted state are thought to be of importance for the prediction of clinical outcome. However, the nature and severity of these steroid abnormalities are still unclear. The aim of our study was to evaluate the levels of salivary cortisol and DHEA-S in remitted depressed patients (rMDD) highly vulnerable for recurrences, as compared to a matched healthy control group.

Methods

The present study was part of the DELTA study, a randomised trial on the effectiveness of a preventive cognitive behavioral module in rMDD patients with at least two depressive episodes in the past. At baseline level mean morning cortisol and DHEA-S, mean evening cortisol and DHEA-S, mean morning and evening cortisol/DHEA-S ratio and mean morning–evening difference for both cortisol and DHEA-S were determined, in 127 patients. Steroid levels will be compared with those of an age and gender matched control group (n = 75), free from medical illness, life time psychiatric disorders and life time psychiatric disorders in first degree relatives.

Results

Data are currently analysed. Differences in steroid levels between the rMDD and the control group will be calculated. In rMDD associations will be calculated between steroid levels and the number of previous relapses, the use of antidepressants, gender and age.

Discussion

This is the first large scale study in rMDD comparing the levels of salivary cortisol, DHEA-S and the cortisol/DHEA-S ratio, with the levels from an age and gender matched healthy control group. We will discuss the nature and severity of the steroid abnormalities found in rMDD and the implications for further study upon the prediction of clinical outcome.