ArticlePloS one2014
Relative hypo- and hypercortisolism are both associated with depression and lower quality of life in bipolar disorder: a cross-sectional study.
Article in PloS one, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 2 of them syntheses that pooled it.
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Who cites it
31 citing papers in PubMed, 2 syntheses or guidelines pooled it, 68 citations in OpenAlex.
- Biological Markers of Burnout Severity: A Systematic Review.Stress and health : journal of the International Society for the Investigation of Stress · 2026Pooled it
- Cortisol levels, motor, cognitive and behavioral symptoms in Parkinson's disease: a systematic review.Journal of neural transmission (Vienna, Austria : 1996) · 2019Pooled it
- Elevated heat shock proteins in bipolar disorder patients with hypothalamic pituitary adrenal axis dysfunction.Medicine · 2018Trial
- Dexamethasone facilitates fear extinction and safety discrimination in PTSD: A placebo-controlled, double-blind study.Psychoneuroendocrinology · 2017Trial
- Association of prenatal alcohol exposure and prenatal depressive symptoms with offspring hair cortisol in childhood and adolescence.BMC psychiatry · 2025Article
- Phenomenon of hypocortisolism in individuals with obesity.Comprehensive psychoneuroendocrinology · 2025Article
- Psilocybin for dementia prevention? The potential role of psilocybin to alter mechanisms associated with major depression and neurodegenerative diseases.Pharmacology & therapeutics · 2024Review
- The effects of IPV and mental health symptoms on HPA axis functioning during early pregnancy.Archives of women's mental health · 2024Article
- Identifying plasma metabolic characteristics of major depressive disorder, bipolar disorder, and schizophrenia in adolescents.Translational psychiatry · 2024Article
- Metabolic Fingerprints of Effective Fluoxetine Treatment in the Prefrontal Cortex of Chronically Socially Isolated Rats: Marker Candidates and Predictive Metabolites.International journal of molecular sciences · 2023Article
- Fish and chips: Using machine learning to estimate the effects of basal cortisol on fish foraging behavior.Frontiers in behavioral neuroscience · 2023Article
- Review
- Stress Hormones Cortisol and Aldosterone, and Selected Markers of Oxidative Stress in Response to Long-Term Supplementation with Omega-3 Fatty Acids in Adolescent Children with Depression.Antioxidants (Basel, Switzerland) · 2022Article
- Chronic Stress in Bipolar Disorders Across the Different Clinical States: Roles of HPA Axis and Personality.Neuropsychiatric disease and treatment · 2022Article
- Pathophysiology of Major Depression by Clinical Stages.Frontiers in psychology · 2021Article
- FKBP5 and early life stress affect the hippocampus by an age-dependent mechanism.Brain, behavior, & immunity - health · 2020Article
- Cortisol levels in unmedicated patients with unipolar and bipolar major depression using hair and saliva specimens.International journal of bipolar disorders · 2020Article
- Psycho-Neuroendocrine-Immune Interactions in COVID-19: Potential Impacts on Mental Health.Frontiers in immunology · 2020Article
- Does Visual Speed of Processing Training Improve Health-Related Quality of Life in Assisted and Independent Living Communities?: A Randomized Controlled Trial.Innovation in aging · 2020Article
- Direct sunlight exposure reduces hair cortisol levels in rhesus monkeysZoological research · 2019Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDepression in unipolar and bipolar disorders is associated with hypothalamic-pituitary-adrenal-axis (HPA-axis) hyperactivity. Also, unipolar disorder has recently been shown to exhibit HPA-axis hypoactivity. We studied for the first time how HPA-axis hypo- and hyperactivity relate to depression and disease burden in bipolar disorder. We were interested in studying hypocortisolism; characterized by increased HPA-axis negative feedback sensitivity and lower basal cortisol levels together with the opposite HPA-axis regulatory pattern of hypercortisolism.
methodsThis cross-sectional study includes 145 type 1 and 2 bipolar outpatients and 145 matched controls. A dexamethasone-suppression-test (DST) measures the negative feedback sensitivity and a weight-adjusted very-low-dose DST was employed, which is sensitive in identifying hypocortisolism and hypercortisolism. The 25th and 75th percentiles of control post-DST values were used as cut-offs identifying patients exhibiting relative hypo-, and hypercortisolism. Self-report questionnaires were employed: Beck-Depression-Inventory (BDI), Montgomery-Åsberg-Depression-Rating-Scale (MADRS-S), World-Health-Organization-Quality-of-Life-Assessment-100 and Global-Assessment-of-Functioning.
resultsPatients exhibiting relative hypocortisolism expectedly exhibited lowered basal cortisol levels (p = 0.046). Patients exhibiting relative hypercortisolism expectedly exhibited elevated basal levels (p<0.001). Patients exhibiting relative hypocortisolism showed 1.9-2.0 (BDI, p = 0.017, MADRS-S, p = 0.37) and 6.0 (p<0.001) times increased frequencies of depression and low overall life quality compared with patients exhibiting mid post-DST values (eucortisolism). Adjusted Odds Ratios (OR:s) for depression ranged from 3.8-4.1 (BDI, p = 0.006, MADRS-S, p = 0.011) and was 23.4 (p<0.001) for life quality. Patients exhibiting relative hypercortisolism showed 1.9-2.4 (BDI, p = 0.017, MADRS-S, p = 0.003) and 4.7 (p<0.001) times higher frequencies of depression and low overall life quality compared with patients exhibiting eucortisolism. Adjusted OR:s for depression ranged from 2.2-2.7 (BDI, p = 0.068, MADRS-S, p = 0.045) and was 6.3 (p = 0.008) for life quality. LIMITATIONS: The cross-sectional design and lack of pre-established reference values of the DST employed.
conclusionsRelative hypocortisolism and relative hypercortisolism were associated with depression and lower life quality, providing novel insights into the detrimental role of stress in bipolar disorder.
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