An integrated approach to understand biological stress system dysregulation across depressive and anxiety disorders

• Published in: Journal of affective disorders 2021-03, Vol.283, p.139-146
• Main Authors: Vinkers, Christiaan H., Kuzminskaite, Erika, Lamers, Femke, Giltay, Erik J., Penninx, Brenda W.J.H.
• Format: Article
• Language: English
• Subjects: Anxiety Disorders; Autonomic nervous system; Cross-Sectional Studies; Generalized anxiety disorder; Humans; Hydrocortisone; Hypothalamic-pituitary-adrenal axis (HPA-axis); Hypothalamo-Hypophyseal System; Immune system; Major depressive disorder; Netherlands; Panic disorder; Pituitary-Adrenal System; Social anxiety disorder; Stress, Physiological
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2021.01.051

•Affective disorders involve dysregulation of major biological stress systems: the hypothalamic-pituitary-adrenal (HPA)-axis, the immune system, and the autonomic nervous system (ANS).•Depressive and anxiety disorders were significantly associated with changes in three biological stress systems including HPA-axis hyperactivity, increased inflammatory activity, and a higher ANS tone, particularly for integrative and cumulative indexes of these stress systems.•To understand stress system functionality across affective disorders, an integrated approach capturing cumulative stress indices within and across biological stress systems is important. Affective disorders involve dysregulation of major biological stress systems (hypothalamic-pituitary-adrenal (HPA)-axis, immune system, autonomic nervous system (ANS)). Suchdysregulationshave rarely beensimultaneously examined across different stress systems. In the Netherlands Study of Depression and Anxiety (n=2789), we investigated whether current or remitted depressive and/or anxiety disorders (based on the CIDI semi-structured interview), including specific symptom profiles, were associated with separate markers and cumulative indexes of the HPA-axis (cortisol awakening response, evening cortisol, dexamethasone suppression test cortisol), immune system (C-reactive protein, interleukin-6, tumor necrosis factor-α), and ANS (heart rate, respiratory sinus arrhythmia, pre-ejection period). Depressive andanxiety disorderswere significantlyassociated with changes in three biological stress systemsincluding HPA-axis hyperactivity, increased inflammatory activity, and a higher ANS tone, particularly for integrative and cumulative indexes of these stress systems (pFDR