HPA axis and aging in depression: Systematic review and meta-analysis
One of the most consistent findings in the biology of depression is an altered activity of the hypothalamic–pituitary–adrenal (HPA) axis. However, data concerning this issue have never been examined with a focus on the older population. Here we present a systematic review and meta-analysis, based on...
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| Published in | Psychoneuroendocrinology Vol. 41; pp. 46 - 62 |
|---|---|
| Main Authors | , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Kidlington
Elsevier Ltd
01.03.2014
Elsevier |
| Subjects | |
| Online Access | Get full text |
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| Abstract | One of the most consistent findings in the biology of depression is an altered activity of the hypothalamic–pituitary–adrenal (HPA) axis. However, data concerning this issue have never been examined with a focus on the older population. Here we present a systematic review and meta-analysis, based on studies investigating levels of cortisol, adrenocorticotropic hormone (ACTH) and corticotropin-releasing hormone (CRH) in depressed participants older than 60 and compared with healthy controls. We found 20 studies, for a total of 43 comparisons on different indices of HPA axis functioning. Depression had a significant effect (Hedges’ g) on basal cortisol levels measured in the morning (0.89), afternoon (0.83) and night (1.39), but a smaller effect on cortisol measured continuously (0.51). The effect of depression was even higher on post-dexamethasone cortisol levels (3.22), whereas it was non-significant on morning ACTH and CRH levels. Subgroup analyses indicated that various methodological and clinical factors can influence the study results. Overall, older participants suffering from depression show a high degree of dysregulation of HPA axis activity, with differences compared with younger adults. This might depend on several mechanisms, including physical illnesses, alterations in the CNS and immune-endocrinological alterations. Further studies are needed to clarify the implications of altered HPA axis activity in older patients suffering from depression. Novel pharmacological approaches might be effective in targeting this pathophysiological feature, thus improving the clinical outcomes. |
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| AbstractList | Summary One of the most consistent findings in the biology of depression is an altered activity of the hypothalamic–pituitary–adrenal (HPA) axis. However, data concerning this issue have never been examined with a focus on the older population. Here we present a systematic review and meta-analysis, based on studies investigating levels of cortisol, adrenocorticotropic hormone (ACTH) and corticotropin-releasing hormone (CRH) in depressed participants older than 60 and compared with healthy controls. We found 20 studies, for a total of 43 comparisons on different indices of HPA axis functioning. Depression had a significant effect (Hedges’ g ) on basal cortisol levels measured in the morning (0.89), afternoon (0.83) and night (1.39), but a smaller effect on cortisol measured continuously (0.51). The effect of depression was even higher on post-dexamethasone cortisol levels (3.22), whereas it was non-significant on morning ACTH and CRH levels. Subgroup analyses indicated that various methodological and clinical factors can influence the study results. Overall, older participants suffering from depression show a high degree of dysregulation of HPA axis activity, with differences compared with younger adults. This might depend on several mechanisms, including physical illnesses, alterations in the CNS and immune-endocrinological alterations. Further studies are needed to clarify the implications of altered HPA axis activity in older patients suffering from depression. Novel pharmacological approaches might be effective in targeting this pathophysiological feature, thus improving the clinical outcomes. One of the most consistent findings in the biology of depression is an altered activity of the hypothalamic–pituitary–adrenal (HPA) axis. However, data concerning this issue have never been examined with a focus on the older population. Here we present a systematic review and meta-analysis, based on studies investigating levels of cortisol, adrenocorticotropic hormone (ACTH) and corticotropin-releasing hormone (CRH) in depressed participants older than 60 and compared with healthy controls. We found 20 studies, for a total of 43 comparisons on different indices of HPA axis functioning. Depression had a significant effect (Hedges’ g) on basal cortisol levels measured in the morning (0.89), afternoon (0.83) and night (1.39), but a smaller effect on cortisol measured continuously (0.51). The effect of depression was even higher on post-dexamethasone cortisol levels (3.22), whereas it was non-significant on morning ACTH and CRH levels. Subgroup analyses indicated that various methodological and clinical factors can influence the study results. Overall, older participants suffering from depression show a high degree of dysregulation of HPA axis activity, with differences compared with younger adults. This might depend on several mechanisms, including physical illnesses, alterations in the CNS and immune-endocrinological alterations. Further studies are needed to clarify the implications of altered HPA axis activity in older patients suffering from depression. Novel pharmacological approaches might be effective in targeting this pathophysiological feature, thus improving the clinical outcomes. One of the most consistent findings in the biology of depression is an altered activity of the hypothalamic-pituitary-adrenal (HPA) axis. However, data concerning this issue have never been examined with a focus on the older population. Here we present a systematic review and meta-analysis, based on studies investigating levels of cortisol, adrenocorticotropic hormone (ACTH) and corticotropin-releasing hormone (CRH) in depressed participants older than 60 and compared with healthy controls. We found 20 studies, for a total of 43 comparisons on different indices of HPA axis functioning. Depression had a significant effect (Hedges' g) on basal cortisol levels measured in the morning (0.89), afternoon (0.83) and night (1.39), but a smaller effect on cortisol measured continuously (0.51). The effect of depression was even higher on post-dexamethasone cortisol levels (3.22), whereas it was non-significant on morning ACTH and CRH levels. Subgroup analyses indicated that various methodological and clinical factors can influence the study results. Overall, older participants suffering from depression show a high degree of dysregulation of HPA axis activity, with differences compared with younger adults. This might depend on several mechanisms, including physical illnesses, alterations in the CNS and immune-endocrinological alterations. Further studies are needed to clarify the implications of altered HPA axis activity in older patients suffering from depression. Novel pharmacological approaches might be effective in targeting this pathophysiological feature, thus improving the clinical outcomes.One of the most consistent findings in the biology of depression is an altered activity of the hypothalamic-pituitary-adrenal (HPA) axis. However, data concerning this issue have never been examined with a focus on the older population. Here we present a systematic review and meta-analysis, based on studies investigating levels of cortisol, adrenocorticotropic hormone (ACTH) and corticotropin-releasing hormone (CRH) in depressed participants older than 60 and compared with healthy controls. We found 20 studies, for a total of 43 comparisons on different indices of HPA axis functioning. Depression had a significant effect (Hedges' g) on basal cortisol levels measured in the morning (0.89), afternoon (0.83) and night (1.39), but a smaller effect on cortisol measured continuously (0.51). The effect of depression was even higher on post-dexamethasone cortisol levels (3.22), whereas it was non-significant on morning ACTH and CRH levels. Subgroup analyses indicated that various methodological and clinical factors can influence the study results. Overall, older participants suffering from depression show a high degree of dysregulation of HPA axis activity, with differences compared with younger adults. This might depend on several mechanisms, including physical illnesses, alterations in the CNS and immune-endocrinological alterations. Further studies are needed to clarify the implications of altered HPA axis activity in older patients suffering from depression. Novel pharmacological approaches might be effective in targeting this pathophysiological feature, thus improving the clinical outcomes. |
| Author | Mondelli, Valeria Antonioli, Marco Amore, Mario Atti, Anna Rita Innamorati, Marco Belvederi Murri, Martino Pariante, Carmine Masotti, Mattia Mellacqua, Zefiro Menchetti, Marco Zanetidou, Stamatula Ghio, Lucio |
| Author_xml | – sequence: 1 givenname: Martino orcidid: 0000-0002-7262-3528 surname: Belvederi Murri fullname: Belvederi Murri, Martino email: martino.belvederi@gmail.com, martino.belvederi@studio.unibo.it organization: Institute of Psychiatry, Department of Psychological Medicine, King's College London, London, UK – sequence: 2 givenname: Carmine surname: Pariante fullname: Pariante, Carmine organization: Institute of Psychiatry, Department of Psychological Medicine, King's College London, London, UK – sequence: 3 givenname: Valeria surname: Mondelli fullname: Mondelli, Valeria organization: Institute of Psychiatry, Department of Psychological Medicine, King's College London, London, UK – sequence: 4 givenname: Mattia surname: Masotti fullname: Masotti, Mattia organization: Section of Psychiatry, Department of Neuroscience, Oftalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy – sequence: 5 givenname: Anna Rita surname: Atti fullname: Atti, Anna Rita organization: Department of Biomedical and NeuroMotor Sciences – Psychiatry, University of Bologna, Italy – sequence: 6 givenname: Zefiro surname: Mellacqua fullname: Mellacqua, Zefiro organization: Institute of Psychiatry, Department of Psychosis Studies, King's College London, London, UK – sequence: 7 givenname: Marco orcidid: 0000-0003-4331-2461 surname: Antonioli fullname: Antonioli, Marco organization: Department of Biomedical and NeuroMotor Sciences – Psychiatry, University of Bologna, Italy – sequence: 8 givenname: Lucio surname: Ghio fullname: Ghio, Lucio organization: Section of Psychiatry, Department of Neuroscience, Oftalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy – sequence: 9 givenname: Marco surname: Menchetti fullname: Menchetti, Marco organization: Section of Psychiatry, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy – sequence: 10 givenname: Stamatula surname: Zanetidou fullname: Zanetidou, Stamatula organization: Department of Mental Health, AUSL Bologna, Italy – sequence: 11 givenname: Marco orcidid: 0000-0003-1389-2290 surname: Innamorati fullname: Innamorati, Marco organization: Department of Neurosciences Division of Psychiatry, University of Parma, Parma, Italy – sequence: 12 givenname: Mario surname: Amore fullname: Amore, Mario organization: Section of Psychiatry, Department of Neuroscience, Oftalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy |
| BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28373599$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/24495607$$D View this record in MEDLINE/PubMed |
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| CODEN | PSYCDE |
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| Snippet | One of the most consistent findings in the biology of depression is an altered activity of the hypothalamic–pituitary–adrenal (HPA) axis. However, data... Summary One of the most consistent findings in the biology of depression is an altered activity of the hypothalamic–pituitary–adrenal (HPA) axis. However, data... One of the most consistent findings in the biology of depression is an altered activity of the hypothalamic-pituitary-adrenal (HPA) axis. However, data... |
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| SubjectTerms | ACTH Adrenocorticotropic Hormone - metabolism Adult and adolescent clinical studies Aging - physiology Aging - psychology Antidepressant Behavioral psychophysiology Biological and medical sciences Corticotropin-Releasing Hormone - metabolism Cortisol CRH Depression Depression - metabolism Depression - physiopathology Depressive symptoms Dexamethasone Elderly Endocrinology & Metabolism Fundamental and applied biological sciences. Psychology Hormones and behavior HPA axis Humans Hydrocortisone - metabolism Hypothalamo-Hypophyseal System - physiopathology Medical sciences Miscellaneous Mood disorders Neuropharmacology Older adults Pharmacology. Drug treatments Pituitary-Adrenal Function Tests Pituitary-Adrenal System - physiopathology Psychiatry Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease) Psychology. Psychoanalysis. Psychiatry Psychology. Psychophysiology Psychopathology. Psychiatry Psychopharmacology |
| Title | HPA axis and aging in depression: Systematic review and meta-analysis |
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