Why the study?
Is the cortisol awakening response blunted in patients with poststroke depression compared to caregiver controls?
Is the cortisol awakening response blunted in patients with poststroke depression compared to caregiver controls?
Poststroke depression is associated with a dysfunctional hypothalamic-pituitary-adrenal axis, as indicated by a blunted cortisol awakening response that correlates with depression severity.
Blunted CAR may indicate HPA involvement in PSD; leaves open causal role and need for prospective outcome studies.
It is important to reduce poststroke depression (PSD) to improve the stroke outcomes and quality of life in stroke patients, but the underlying mechanisms of PSD are not completely understood. As many studies implicate dysregulation of hypothalamic-pituitary-adrenal axis in the etiology of major depression and stroke, we compared the cortisol awakening response (CAR) of 28 admitted PSD patients with that of 23 age-matched caregiver controls. Saliva samples for cortisol measurement were collected immediately, 15, 30, and 45 min after awakening for two consecutive days. Depressive mood status in PSD patients was determined with Beck Depression Inventory and Hamilton Depression Rating Scale. Salivary cortisol levels of PSD patients did not rise significantly at any sampling time, showing a somewhat flat curve. Caregiver controls showed significantly higher CAR at 15 and 30 min after awakening compared to PSD patients even though the two groups did not differ at awakening or 45 min after awakening. Area-under-the-curve analysis revealed a significant negative correlation between the CAR and the degree of depression in PSD patients. Thus, our findings suggest that poststroke depression is closely related with dysfunctional HPA axis indicated by blunted CAR.
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Kwon et al. (2015) studied this question.
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