Cortisol trajectory, melancholia, and response to electroconvulsive therapy

Area of Science:

• Neuroscience
• Psychiatry
• Endocrinology

Background:

• Biomarkers for psychiatric disorders, particularly depression, are largely elusive.
• Abnormalities in the hypothalamic-pituitary-adrenal (HPA) axis are observed in severe depression.
• Individual differences in HPA axis function may contribute to depression heterogeneity and treatment response.

Purpose of the Study:

• To investigate if temporal cortisol trajectories in hair predict electroconvulsive therapy (ECT) response in treatment-resistant depression.
• To explore the association between cortisol trajectories and clinical features of depression, including melancholia.

Main Methods:

• Scalp hair samples were collected from 39 subjects with treatment-resistant depression before ECT.
• Cortisol concentrations in sequential hair segments were analyzed to reconstruct cortisol trajectory over the 12 weeks preceding ECT.
• A classification algorithm was used to assess the predictive accuracy of cortisol trajectory for ECT response.

Main Results:

• Cortisol trajectories varied significantly among individuals, with some associations found with melancholia and global severity.
• ECT non-responders exhibited a decreasing cortisol trajectory in the 8 weeks before ECT (p=0.004).
• Cortisol trajectory independently predicted ECT response with 80% accuracy, irrespective of clinical features.

Conclusions:

• Hair cortisol trajectory serves as a promising, noninvasive biomarker for predicting ECT response in severely depressed individuals.
• This biomarker may help identify patients likely to benefit from ECT, aiding personalized treatment strategies.
• Further validation in larger cohorts is warranted to establish clinical utility.