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Cortisol awakening response and subsequent depression: prospective longitudinal study.

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Summary

This study found no link between salivary cortisol levels, including the cortisol awakening response, and the short-term risk of developing depression in adolescents. The findings suggest any potential association is too small to be clinically significant.

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Area of Science:

  • Endocrinology
  • Psychiatry
  • Neuroscience

Background:

  • Inconsistent findings exist regarding the association between elevated cortisol and subsequent depression.
  • The cortisol awakening response (CAR) is proposed as a more stable indicator of hypothalamic-pituitary-adrenal (HPA) axis function and stress reactivity.

Purpose of the Study:

  • To examine the relationship between salivary cortisol, specifically the CAR, and the incidence of depression in a large adolescent cohort.
  • To determine if HPA axis function, as measured by salivary cortisol, predicts future depressive illness.

Main Methods:

  • Salivary cortisol was measured in 841 adolescents (aged 15) over 3 school days at four time points.
  • Logistic regression analysis was employed to assess odds ratios for depression (ICD-10 criteria) at age 18.
  • Cortisol awakening response, diurnal drop, and area under the curve were analyzed.

Main Results:

  • No significant evidence was found linking salivary cortisol measures to subsequent depression.
  • Odds ratios for the cortisol awakening response were not statistically significant (OR 1.24, P=0.14 before adjustment; OR 1.12, P=0.61 after adjustment).
  • Other cortisol parameters, including individual time points, diurnal variation, and overall exposure, showed no association with depression risk.

Conclusions:

  • The study does not support the hypothesis that elevated salivary cortisol increases short-term depression risk.
  • If an association exists between salivary cortisol and depression, it is likely small and not clinically relevant.
  • These findings contribute to understanding the complex relationship between HPA axis activity and mental health outcomes.