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Cortisol secretion in prepubertal children with major depressive disorder. Episode and recovery
J Puig-Antich1, R Dahl, N Ryan
1Department of Child Psychiatry, New York State Psychiatric Institute, New York.
Insights
Cortisol secretion abnormalities are infrequent in prepubertal children with major depressive disorder (MDD). Even during depressive episodes, cortisol levels in these children did not significantly differ from controls in a low-stress setting.
Area of Science:
- Neuroendocrinology
- Child Psychiatry
- Psychobiology
Background:
- Major depressive disorder (MDD) in children is a significant concern.
- The hypothalamic-pituitary-adrenal (HPA) axis, particularly cortisol secretion, is often implicated in depression.
- Previous research suggests potential HPA axis dysregulation in pediatric depression, but findings can be inconsistent.
Purpose of the Study:
- To investigate plasma cortisol secretion patterns in prepubertal children with MDD.
- To compare cortisol levels between children with MDD, nonaffective psychiatric disorders, and healthy controls.
- To examine if cortisol secretion abnormalities are linked to specific MDD subtypes or persist after recovery.
Main Methods:
- 24-hour plasma cortisol levels were measured every 20 minutes in 45 drug-free prepubertal children with MDD, 20 with nonaffective psychiatric disorders, and 8 controls.
- All participants were studied in a low-stress environment.
- Cortisol secretion was analyzed for mean, peak, nocturnal rise, and nadir values, and subgroups of MDD patients were examined.
Main Results:
- No significant differences in 24-hour mean, peak, nocturnal rise, or nadir cortisol concentrations were found among the three groups.
- Subgroup analyses of MDD patients (based on endogenicity, psychosis, suicidality) did not reveal significant cortisol secretion differences.
- Cortisol hypersecretion was rare, observed in only 4 depressed children and 1 control; it did not consistently persist after recovery.
Conclusions:
- Abnormalities in cortisol secretion appear infrequent in prepubertal children with major depression when assessed in a non-stressful environment.
- The study challenges the notion of consistent HPA axis hyperactivity in this population under specific conditions.
- Findings suggest that environmental factors and stress levels may play a crucial role in observed cortisol dysregulation in pediatric depression.
Abstract:
Plasma cortisol concentrations were measured every 20 minutes for 24 hours in a group of 45 rigorously assessed, drug-free, prepubertal children who met the unmodified Research Diagnostic Criteria for major depressive disorder (MDD), 20 children with nonaffective psychiatric disorders, and eight normal controls. All children were studied in a low-stress environment. There were no significant differences in plasma cortisol concentration among the three groups as measured by 24-hour mean, peak, nocturnal rise, or nadir values. Division of the MDD group into subgroups based on endogenicity, psychotic symptoms, and suicidality also failed to reveal significant differences for cortisol secretion. Hypersecretion of cortisol (defined as 2 SDs above the grand mean) was identified in only four children with depressive illness and one normal control. Following clinical recovery, 24 depressed children were restudied in a drug-free state and compared with themselves during the episode of illness and with both groups of controls. No significant differences in plasma cortisol concentrations were found. All four depressed hypersecretors were restudied after clinical recovery, and one showed persistence of hypersecretion. These results suggest that abnormalities of cortisol secretion occur infrequently in prepubertal children with major depression when they are studied in a nonstressful environment.