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Cortisol as a predictor of psychological therapy response in depressive disorders: systematic review and
Susanne Fischer1, Rebecca Strawbridge2, Andres Herane Vives2
1Susanne Fischer, PhD, Rebecca Strawbridge, MSc, Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Andres Herane Vives, MD, DPM, MSc, Universidad Católica del Norte, Coquimbo, Chile and Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Anthony J. Cleare, BSc, MBBS, FRCPsych, PhD, Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK susanne.fischer@kcl.ac.uk.
Background:
Many patients with depressive disorders demonstrate resistance to psychological therapy. A frequent finding is hypothalamic-pituitary-adrenal (HPA) axis alterations. As cortisol is known to modulate cognitive processes, those patients may be less likely to profit from psychological therapy.
Aims:
To conduct a systematic review and meta-analysis on cortisol as a predictor of psychological therapy response.
Method:
The Cochrane Library, EMBASE, MEDLINE and PsycINFO databases were searched. Records were included if they looked at patients with any depressive disorder engaging in psychological therapy, with a pre-treatment cortisol and a post-treatment symptom measure.
Results:
Eight articles satisfied our selection criteria. The higher the cortisol levels before starting psychological therapy, the more symptoms patients with depression experienced at the end of treatment and/or the smaller their symptom change.
Conclusions:
Our findings suggest that patients with depression with elevated HPA functioning are less responsive to psychological therapy.
