Cortisol levels in chronic fatigue syndrome and atypical depression measured using hair and saliva specimens

• Published in: Journal of affective disorders 2020-04, Vol.267, p.307-314
• Main Authors: Herane-Vives, Andres, Papadopoulos, Andrew, de Angel, Valeria, Chua, Kia-Chong, Soto, Lilian, Chalder, Trudie, Young, Allan H, Cleare, Anthony J
• Format: Article
• Language: English
• Subjects: Depression; Depressive Disorder, Major - diagnosis; Fatigue Syndrome, Chronic - diagnosis; Humans; Hydrocortisone; Saliva
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2020.01.146

•Chronic fatigue syndrome (CFS) and atypical MDE (A-MDE) share several clinical and neurobiological features, such as low short-term cortisol output, using saliva samples.•Decreased short-term cortisol level may be transient since cortisol levels were normal when long-term cortisol level, using hair specimen was studied.•Both disorders may be part of the wider group of somatic symptom disorder (SSD), given the similar cortisol and clinical results. Several diagnostic criteria for major depressive disorder (MDE) overlap with those of Chronic Fatigue Syndrome (CFS). Furthermore, atypical MDE (A-MDE), a subtype of MDE characterised by profound fatigue and which has frequently been linked with CFS, exhibits similar low cortisol levels to CFS. However, this result has been only found in specimens designed for measuring acute cortisol levels. In this study, we measure cortisol levels in subjects with CFS and in subjects with A-MDE, without psychiatric comorbidity, using both hair and saliva specimens, to gain a measure of both short and long-term cortisol levels in these two conditions. Hair cortisol concentration, representing the cortisol concentration of the previous three months, and salivary cortisol, measured at six time-points across one day and including the cortisol awakening response (CAR), post-awakening delta cortisol and the total daily output, were assessed in an age and gender matched group of 34 controls, 15 subjects with A-MDE and 17 with CFS. CFS (mean 92.2 nmol/l.h, s.d. 33.2 nmol/l.h) and A-MDE (mean 89.1 nmol/l.h, s.d. 22.6 nmol/l.h) subjects both showed lower cortisol total daily output in saliva (AUCg) in comparison to healthy controls (mean 125.5 nmol/l.h, s.d. 40.6 nmol/l.h). However, hair cortisol concentration was not lower than that of controls in either patient group. CFS and A-MDE did not differ from one another on any cortisol measures. CFS subjects reported fewer daily hassles and less severe psychic anxiety symptoms in comparison to A-MDE subjects (all p