Bidirectional cortisol dysregulation in depressive disorders: Pathophysiological mechanisms and therapeutic implications

They assessed the relevance of retrieved studies and synthesized evidence from clinical, peripheral-cell, postmortem, and animal studies.Sa RL and Chen ZX jointly formulated the review question, developed the framework for organizing evidence by the direction and dimension of cortisol dysregulation, and contributed equally to interpreting the literature and drafting and revising the manuscript.Sa RL led the conceptualization of the review, articulated its central perspective that cortisol dysregulation in depressive disorders is heterogeneous and multidimensional rather than uniformly hypercortisolemic, and acquired funding.Chen ZX critically compared findings across cortisol measures and study populations, refined the interpretation and presentation of the review's arguments, and edited the manuscript.Wen Z conducted the literature investigation, prepared the original draft, and prepared the figures and summary tables.