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. 2012 Feb;136(3):350-8.
doi: 10.1016/j.jad.2011.11.027. Epub 2011 Dec 10.

Associations between suicide attempts and elevated bedtime salivary cortisol levels in bipolar disorder

Masoud Kamali  1 , Erika F H Saunders, Alan R Prossin, Christine B Brucksch, Gloria J Harrington, Scott A Langenecker, Melvin G McInnis
Affiliations

Associations between suicide attempts and elevated bedtime salivary cortisol levels in bipolar disorder

Masoud Kamali et al. J Affect Disord. 2012 Feb.

Abstract

Background: Hypothalamic-pituitary-adrenal (HPA) axis abnormalities have been reported in bipolar disorder and also in suicidal behavior, but few studies have examined the relationship between suicidal behaviors and the HPA axis function in bipolar disorder, attending to and minimizing confounding factors. We compare HPA axis activity in bipolar individuals with and without suicidal behavior and unaffected healthy controls through measurement of salivary cortisol.

Method: Salivary cortisol was collected for three consecutive days in 29 controls, 80 bipolar individuals without a history of suicide and 56 bipolar individuals with a past history of suicide. Clinical factors that affect salivary cortisol were also examined.

Results: A past history of suicide was associated with a 7.4% higher bedtime salivary cortisol level in bipolar individuals. There was no statistical difference between non-suicidal bipolar individuals and controls in bedtime salivary cortisol and awakening salivary cortisol was not different between the three groups.

Limitations: The measure of salivary cortisol was a home based collection by the study subjects and the retrospective clinical data was primarily based on their historical account.

Conclusions: Bipolar individuals with a past history of suicidal behavior exhibit hyperactivity in the HPA axis. This biological marker remains significant regardless of demographic factors, mood state, severity and course of illness. This finding in bipolar disorder is consistent with the evidence for altered HPA axis functioning in suicide and mood disorders and is associated with a clinical subgroup of bipolar patients at elevated risk for suicide based on their history, and in need of further attention and study.

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Conflict of interest statement

Conflict of interest

In the past 5 years Dr. McInnis has received honoraria for service on speaker's bureaus or consultative boards with Pfizer, BMS, GSK, Astra-Zeneca, Eli Lilly, Janssen, and Merck Pharmaceuticals. All other authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Levels of bedtime salivary cortisol in bipolar individuals based on severity of suicidal thoughts and behaviors. Error Bars: 95% CI.
See this image and copyright information in PMC

References

    1. Allison PD. Multiple Regression: A Primer. USA: Pine Forge Press; 1999.
    1. Badrick E, Kirschbaum C, Kumari M. The relationship between smoking status and cortisol secretion. Journal of Clinical Endocrinology and Metabolism. 2007;92:819–824. - PubMed
    1. Black D, Monahan P, Winokur G. The relationship between DST results and suicidal behavior. Annals of Clinical Psychiatry. 2002;14:83–88. - PubMed
    1. Carroll BJ, Feinberg M, Greden JF, Tarika J, Albala AA, Haskett RF, James NM, Kronfol Z, Lohr N, Steiner M, de Vigne JP, Young E. A specific laboratory test for the diagnosis of melancholia. Standardization, validation, and clinical utility. Archives of General Psychiatry. 1981;38:15–22. - PubMed
    1. Cassidy F, Ritchie JC, Carroll BJ. Plasma dexamethasone concentration and cortisol response during manic episodes. Biological Psychiatry. 1998;43:747–754. - PubMed

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