Increased Cortisol Levels in Depression: A Comparative Study Evaluating the Correlation of Hypercortisolemia with Prosocial Coping Mechanisms

Theodor Moica 1 , Iosif Gabos Grecu 1 , Gabriela Elena Buicu 2 , Melinda Ferencz 1 , Marieta Gabos Grecu 1 , Andreea Sălcudean 1 , and Cosmin Octavian Popa 2
  • 1 University of Medicine and Pharmacy Tîrgu Mureş, First Clinic of Psychiatry
  • 2 University of Medicine and Pharmacy Tîrgu Mureş, Mental Health Center


Objective: The aim of this paper was to evaluate if depressed patients have an increased level of morning serum cortisol compared to healthy persons and to assess the relation between high levels of cortisol and prosocial coping mechanisms, in the context of Recurrent Major Depressive Disorder. Methods: Morning serum cortisol level was measured in 15 depressed patients hospitalized in First Clinic of Psychiatry Tirgu Mures and in 15 healthy controls. We have analyzed 3 behavioral coping strategies with The Strategic Approach of Coping Scale (SACS): social joining (SJ), seeking social support (SSS) and cautious action (CA). Results: 30 participants were included, the mean value of the cortisol for females was Mcort_female= 16.38 μg/dl and for males Mcort_male= 16.31 μg/dl. Independent sample t test showed that the cortisol level in depressed group was higher than the cortisol level in the control group: t = 2.394, p < 0.05 (0.024). In the MDD group the Spearman correlation between the level of serum cortisol and prosocial coping strategies was: rcortisol-SJ= -0.519; rcortisol-SSS= -0.107; rcortisol-CA= -0.382. Conclusions: Although the studied sample patient was small, we can conclude that the patients with Recurrent Major Depressive Disorder have an increased level of morning serum cortisol compared to healthy persons. In these patients there is an inverse correlation between the increased levels of morning cortisol and the frequency of use of the effective prosocial coping strategies, particularly the social joining type.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. Monnier J, Hobfoll SE, Dunahoo CL, HuIizer MR, Johnson R. There’s more than rugged individualism in coping. Part 2: Construct validity and further model testing. Anxiety, Stress, Coping: An International Journal. 1998;11(3):247-27.

  • 2. Talău G, Duică L, Nicoară D, et al. Interrelaţii hipocamp - axa hipotalamohipofizo- corticosprarenaliană in tulburarea depresivă. Romanian Journal of Psychofarmacology. 2005;5(1-2):45-50.

  • 3. Maletic V, Robinson M, Oakes T, et al. Neurobiology of depression: an integrated view of key Findings. Int J Clin Pract. 2007;61 (12):2030-2040.

  • 4. Gianluca S. Neuroplasticity and major depression, the role of modern antidepressant drugs. World J Psychiatry. 2012;2(3):49-57.

  • 5. Marinescu D, Mogoanta L, Udristoiu T, Udristoiu I, Pirici D. The neuroprotective potentially of agomelatine - animal model study. European Psychiatry. 2011;26(1):1256.

  • 6. Mondelli V, Pariante C, Navari S, et al. Higher cortisol levels are associated with smaller left hippocampal volume in first-episode psychosis. Schizophr Res. 2010;119(1-3):75-8.

  • 7. Steen R, Mull C, McClure R, Hamer R, Lieberman J. Brain volume in first-episode schizophrenia: systematic review and meta-analysis of magnetic resonance imaging studies. Br J Psychiatry. 2006;188:510-8.

  • 8. Velakoulis D, Wood S, Wong M, et al. Hippocampal and amygdala volumes according to psychosis stage and diagnosis: a magnetic resonance imaging study of chronic schizophrenia, first-episode psychosis, and ultra-high-risk individuals. Arch Gen Psychiatry. 2006;63(2):139-49.

  • 9. Ryan M, Sharifi N, Condren R, Thakore J. Evidence of basal pituitary-adrenal overactivity in first episode, drug naive patients with schizophrenia. Psychoneuroendocrinology. 2004;29(8):1065-70.

  • 10. Mondelli V, Dazzan P, Hepgul N, et al. Abnormal cortisol levels during the day and cortisol awakening response in first-episode psychosis: the role of stress and of antipsychotic treatment. Schizophr Res. 2010;116(2-3):234-42.

  • 11. Wolkowitz O, Rowen J, Mason S, et al. Cortisol awakening response and cortisol/DHEA ratio associations with hippocampal volume in MDD. European Journal of Psychotraumatology. 2012;3(1).

  • 12. Dedovic KEV, Duchesne A, Lue S, et al. Cortisol awakening response and hippocampal volume: vulnerability for major depressive disorder? Biol Psychiatry. 2010;68(9):847-53.

  • 13. Holsboer F. Redesigning antidepressant drug discovery. Dialogues Clin Neurosci. 2014;16(1):5-7.

  • 14. Mossner R, Mikova O, Koutsilieri E, et al. Consensus paper of the WFSBP Task Force on Biological Markers: biological markers in depression. World J Biol Psychiatry. 2007;8(3):141-74.

  • 15. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, (DSM-IV). fourth ed ed. Washington DC: American Psychiatric Association; 1994.

  • 16. Budău O, Albu M. SACS - Scala de Abordare Strategică a Coping-ului. Cluj Napoca: Editura ASCR; 2010.

  • 17. Sadock BJ, Sadock VA. Kaplan and Sadock’s Synopsis of Psychiatry. In: Lippincott Williams &Wilkins; Philadelphia. 2007;p.814.

  • 18. Cowen PJ. Cortisol, serotonin and depression: all stressed out? BJ Psych. 2002;180:99-100.

  • 19. Mihăilescu A, Năstase S, Matei V, Greabu M, Totan A. Investigation of emotional distress and salivary cortisol in young healthy subjects in the period of acute stress. Revista Medicală Romană. 2011;LVIII (1):45-51.

  • 20. Bhagwagar Z, Hafizi S, J P. Cowen Increased salivary cortisol after waking in depression. Psychopharmacology. 2005;182(1):54-57.

  • 21. Vythilingam M, Vermetten E, Anderson G, et al. Hippocampal volume, memory, and cortisol status in major depressive disorder: effects of treatment. Biol Psychiatry. 2004;56(2):101-12.

  • 22. Dedovic K NJ. The cortisol awakening response and major depression: examining the evidence. Neuropsychiatr Dis Treat. 2015;11:1181-9.

  • 23. Yip C, Stewart S, Imran F, et al. The role of morning basal serum cortisol in assessment of hypothalamic pituitary-adrenal axis. Clin Invest Med. 2013;36(4):E216-22.

  • 24. Karaca Z, Tanriverdi F, Atmaca H, et al. Can basal cortisol measurement be an alternative to the insulin tolerance test in the assessment of the hypothalamic-pituitary-adrenal axis before and after pituitary surgery? Eur J Endocrinol. 2010;163(3):377-82.

  • 25. Portella M, Harmer C, Flint J, Cowen P, Goodwin G. Enhanced early morning salivary cortisol in neuroticism. Am J Psychiatry. 2005;162(4):807-809.

  • 26. Sjogren E, Leanderson P, Kristenson M. Diurnal saliva cortisol levels and relations to psychosocial factors in a population sample of middle-aged Swedish men and women. Int J Behav Med. 2006;13(3):193-200.

  • 27. Vreeburg S, Hartman C, Hoogendijk W. Parental history of depression or anxiety and the cortisol awakening response. Br J Psychiatry. 2010;197(3):180-185.

  • 28. Adam E, Doane L, Zinbarg R, et al. Prospective prediction of major depressive disorder from cortisol awakening responses in adolescence. Psychoneuroendocrinology. 2010;35(6):921-931.

  • 29. Vrshek-Schallhorn S, Doane L, Mineka S, et al. The cortisol awakening response predicts major depression: predictive stability over a 4-year follow-up and effect of depression history. Psychol Med. 2013;43(3):483-493.

  • 30. Hardeveld F, Spijker J, Vreeburg S, et al. Increased cortisol awakening response was associated with time to recurrence of major depressive disorder. Psychoneuroendocrinology. 2014;50:62-71.

  • 31. Stroud C, Davila J, Hammen C, Vrshek-Schallhorn S. Severe and nonsevere events in first onsets versus recurrences of depression: evidence for stress sensitization. J Abnorm Psycho. 2011;120(1):142-154.

  • 32. Hutchinson J, Williams P. Neuroticism, daily hassles, and depressive symptoms: an examination of moderating and mediating effects. Pers Individ Dif. 2007;42:1367-1378.

  • 33. Sher L. Daily hassles, cortisol, and the pathogenesis of depression. Med Hypotheses. 2004;62(2):198-202.

  • 34. Ashton E, O'Shea K, Maldonado J, et al. Social support and maladaptive coping as predictors of the change in physical health symptoms among persons living with HIV/AIDS. AIDS Patient Care STDS. 2005 September;19(9):587-98.

  • 35. Hobfoll S, Schroeder K. Distinguishing between Passive and Active Prosocial Coping: Bridging Inner-City Women’s Mental Health and Aids Risk Behavior. Journal of Social and Personal Relationships. 2001;18:201-217.


Journal + Issues