Back to Search
Start Over
Cortisol trajectory, melancholia, and response to electroconvulsive therapy
- Source :
- Journal of Psychiatric Research. 103:46-53
- Publication Year :
- 2018
- Publisher :
- Elsevier BV, 2018.
-
Abstract
- 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.
- Subjects :
- Adult
Male
medicine.medical_specialty
Hydrocortisone
medicine.medical_treatment
Drug Resistance
behavioral disciplines and activities
Article
Young Adult
03 medical and health sciences
Basal (phylogenetics)
Hpa activity
0302 clinical medicine
Electroconvulsive therapy
Internal medicine
mental disorders
Melancholia
medicine
Humans
Prospective Studies
Electroconvulsive Therapy
Cortisol level
Biological Psychiatry
Depression (differential diagnoses)
Aged
Aged, 80 and over
Psychiatric Status Rating Scales
Depressive Disorder
business.industry
Middle Aged
030227 psychiatry
Psychiatry and Mental health
Treatment Outcome
medicine.anatomical_structure
Scalp
Cardiology
Biomarker (medicine)
Female
medicine.symptom
business
030217 neurology & neurosurgery
Hair
Subjects
Details
- ISSN :
- 00223956
- Volume :
- 103
- Database :
- OpenAIRE
- Journal :
- Journal of Psychiatric Research
- Accession number :
- edsair.doi.dedup.....308c842aa056cc74184c5a4aeacc34f2