Cortisol stress reactivity across psychiatric disorders: A systematic review and meta-analysis
Zorn, J. V., Schür, R. R., Boks, M. P., Kahn, R. S., Joëls, M., & Vinkers, C. H. (2017)
Psychoneuroendocrinology, 77, 25–36.
doi:10.1016/j.psyneuen.2016.11.036

Introduction

The hypothalamus-pituitary-adrenal (HPA) axis and its end product cortisol are essential for an adequate response to stress.
A dynamic cortisol response, marked by a rapid rise and decline in cortisol levels following stress, is thought to be adaptive and to facilitate adequate coping with perceived threats in the environment.
Changes in cortisol stress reactivity may increase susceptibility to the negative effects of stress.

Prolonged, excessive or insufficient activation of the HPA axis may lead to changes in the brain and may subsequently result in the development of psychiatric disorders.

Discussion

 There are sex-specific changes in cortisol stress reactivity for MDD and anxiety disorders.
Women with current MDD or an anxiety disorder exhibit a blunted cortisol stress response compared with healthy controls.
Men with current MDD or SAD show an elevated cortisol response.

For schizophrenia, the cortisol response to psychosocial stress is blunted in both male and female patients.

Influence of sex and sex hormones

Sex is an important factor when studying cortisol stress reactivity across psychiatric disorders.

Women in the luteal phase of the menstrual cycle have a similar cortisol response as men, while women in the follicular phase, menopause and those using oral contraceptives show blunting of the cortisol response.

Higher testosterone levels were associated with lower cortisol responses in men and higher progesterone levels had the same effect in women.

Despite the rise of sex hormones in response to acute stress, baseline levels of testosterone, estradiol and progesterone could partially explain sex differences in cortisol stress reactivity.

The cortisol stress response as a resilience marker

There is a dynamic cortisol stress response in relation to psychiatric illness.
The response was altered in patients with current MDD or an anxiety disorder.

Recurrent episodes of MDD change the cortisol response more permanently.

Women with current MDD or an anxiety disorder exhibit a blunted cortisol response to psychosocial stress compared to healthy controls.
Male patients with current MDD or SAD show an elevated cortisol response to psychosocial stress.