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Hypothalamic-pituitary-adrenal axis activity in older persons with and without a depressive disorder.

Psychoneuroendocrinology (2014-12-03)
D Rhebergen, N C M Korten, B W J H Penninx, M L Stek, R C van der Mast, R Oude Voshaar, H C Comijs
ABSTRACT

Altered functioning of the hypothalamic-pituitary-adrenal axis (HPA-axis) has been associated with depression, but findings have been inconsistent. Among older depressed persons, both hyperactivity and hypo-activity of the HPA-axis were demonstrated. However, most studies were population-based studies, with single cortisol measurements, lacking insight into diurnal patterns of HPA-axis functioning. We aim to provide insight into functioning of the HPA-axis, assessed by various salivary cortisol samples, in depressed older adults and non-depressed controls. Data were derived from the Netherlands Study of Depression in Older Persons. Cortisol levels of older persons without a lifetime diagnosis of depression and/or anxiety (n=109) were compared with older persons with a 6-month major depression diagnosis (n=311). ANCOVA analyses and random coefficient analysis on the four morning cortisol samples were performed. A possible U-shaped association between cortisol and depression status was examined. Depressed older persons showed higher morning cortisol levels at awakening (T1) and a less dynamic awakening response compared to non-depressed older persons. Dexamethasone suppression did not differ across groups. No U-shaped association between HPA-axis activity and depression was observed. We demonstrated a hypercortisolemic state and a diminished ability to respond to the stress of awakening among depressed older persons. Previously it was shown, that hypercortisolemic states may indicate a lifelong biological vulnerability for depression. Our findings expand on previous literature by demonstrating that in older persons the HPA-axis may become less responsive to stress, culminating in a further dysregulation of the diurnal cortisol-rhythm, superimposed on - possibly lifelong - hypercortisolemic states.

MATERIALS
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Brand
Product Description

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Dexamethasone, ≥98% (HPLC), powder
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Dexamethasone, powder, γ-irradiated, BioXtra, suitable for cell culture, ≥80% (HPLC)
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Dexamethasone, tested according to Ph. Eur.
Supelco
Dexamethasone, VETRANAL®, analytical standard
Hydrocortisone for peak identification, European Pharmacopoeia (EP) Reference Standard
Supelco
Dexamethasone, Pharmaceutical Secondary Standard; Certified Reference Material
USP
Dexamethasone, United States Pharmacopeia (USP) Reference Standard
Dexamethasone for system suitability, European Pharmacopoeia (EP) Reference Standard
Dexamethasone, British Pharmacopoeia (BP) Assay Standard
Dexamethasone, European Pharmacopoeia (EP) Reference Standard