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Cortisol as a predictor of psychological therapy response in depressive disorders: Systematic review and meta-analysis

  • Susanne Fischer (a1), Rebecca Strawbridge (a1), Andres Herane Vives (a2) and Anthony J. Cleare (a1)
Abstract
Background

Many patients with depressive disorders demonstrate resistance to psychological therapy. A frequent finding is hypothalamic–pituitary–adrenal (HPA) axis alterations. As cortisol is known to modulate cognitive processes, those patients may be less likely to profit from psychological therapy.

Aims

To conduct a systematic review and meta-analysis on cortisol as a predictor of psychological therapy response.

Method

The Cochrane Library, EMBASE, MEDLINE and PsycINFO databases were searched. Records were included if they looked at patients with any depressive disorder engaging in psychological therapy, with a pre-treatment cortisol and a post-treatment symptom measure.

Results

Eight articles satisfied our selection criteria. The higher the cortisol levels before starting psychological therapy, the more symptoms patients with depression experienced at the end of treatment and/or the smaller their symptom change.

Conclusions

Our findings suggest that patients with depression with elevated HPA functioning are less responsive to psychological therapy.

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Copyright
Corresponding author
Susanne Fischer, King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychological Medicine, Box PO74, 103 Denmark Hill, London SE5 8AF, UK. Email: susanne.fischer@kcl.ac.uk
Footnotes
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Declaration of interest

None.

Footnotes
References
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  • ISSN: 0007-1250
  • EISSN: 1472-1465
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Cortisol as a predictor of psychological therapy response in depressive disorders: Systematic review and meta-analysis

  • Susanne Fischer (a1), Rebecca Strawbridge (a1), Andres Herane Vives (a2) and Anthony J. Cleare (a1)
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