Elsevier

Biological Psychiatry

Volume 59, Issue 7, 1 April 2006, Pages 667-671
Biological Psychiatry

Brief report
Cortisol, the Cortisol-Dehydroepiandrosterone Ratio, and Pro-Inflammatory Cytokines in Patients with Current Major Depressive Disorder Comorbid with Borderline Personality Disorder

https://doi.org/10.1016/j.biopsych.2005.08.001Get rights and content

Background

Major depression in young women is often comorbid with borderline personality disorder (BPD); however, adrenal steroids and pro-inflammatory cytokines in patients with comorbid current major depressive disorder and BPD (MDD/BPD) have not been systematically examined. Therefore, our study aimed at examining serum profiles of cortisol, cytokines, and the cortisol/dehydroepiandrosterone (cortisol/DHEA) ratio in MDD/BPD patients and a healthy comparison group.

Methods

Twelve medication-free female patients with MDD/BPD and 12 healthy women were included. Serum profiles of cortisol, DHEA, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-1β were sampled, and the molar cortisol/DHEA ratio was determined.

Results

Concentrations of serum cortisol, TNF-α, and IL-6, as well as the cortisol/DHEA ratios were significantly increased in MDD/BPD patients as compared with the healthy comparison group.

Conclusions

Depressed patients with comorbid BPD display endocrine and immune alterations similar to those observed in cases of melancholic MDD without BPD. Elevated concentrations of serum cortisol, cortisol/DHEA ratios, and pro-inflammatory cytokines might indicate a state marker in these patients and might contribute to long-term metabolic alterations that have also been associated with MDD.

Section snippets

Methods and Materials

The study was approved by the local ethics committee at the University of Luebeck (Institutional Review Board), and all women in the patient and the comparison group gave their written informed consent before the beginning of the study. Twelve unmedicated female patients consecutively admitted to our hospital who met the DSM-IV diagnostic criteria for current MDD and BPD were included. All patients were drug-free at the time of testing and had not received antidepressant or neuroleptic

Results

Patients and comparison subjects were of comparable age (p = .72) and had comparable smoking habits (p = .89), but patients tended to be heavier (p = .14) and less active (p = .16) (Table 1). Repeated measures ANOVA revealed elevated serum cortisol concentrations [F(1) = 5.2, p = .033] (Figure 1) and an increased cortisol-DHEA ratio in patients when compared with healthy subjects [F(1) = 7.9, p = .01] (Table 2). We found increased serum concentrations of TNF-α [F(1) = 8.5, p = .008] and IL-6 [F

Discussion

We found elevated concentrations of cortisol, as determined on the basis of the serum profiles, in depressed patients with comorbid BPD. Our results point to a dysregulation of the HPAS in these patients and are in line with observations by others who found alterations of the HPAS (elevated free cortisol, cortisol non-suppression) in depressed patients without comorbidity (reviewed by Heuser 1998, Holsboer and Barden 1996). Interestingly, the alterations observed in MDD have been described more

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