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. 2012 Apr;138(1-2):149-52.
doi: 10.1016/j.jad.2011.11.046. Epub 2012 Feb 2.

Plasma cortisol in first episode drug-naïve mania: differential levels in euphoric versus irritable mood

Leandro L Valiengo  1 , Márcio G Soeiro-de-Souza, Andrea H Marques, Doris H Moreno, Mário F Juruena, Ana Cristina Andreazza, Wagner F Gattaz, Rodrigo Machado-Vieira
Affiliations

Plasma cortisol in first episode drug-naïve mania: differential levels in euphoric versus irritable mood

Leandro L Valiengo et al. J Affect Disord. 2012 Apr.

Abstract

Background: Dysregulation of HPA axis has been widely described in subjects with bipolar disorder (BD), including changes in cortisol levels during mood episodes and euthymia. However, most of the studies were done with medicated BD patients with variable length of illness, which was shown to interfere on peripheral cortisol levels. Therefore, the present study aims to evaluate plasma cortisol levels in drug-naïve BD subjects during the first manic episode, as well as investigate the relationship between plasma cortisol levels and manic symptomatology.

Methods: Twenty-six drug-naïve patients were enrolled meeting criteria for a first manic episode in bipolar I disorder. Severity of mania was assessed using the Young Mania Rating Scale (YMRS). The control group included 27 healthy subjects matched by age and gender. Cortisol was quantified using a direct radioimmunoassay.

Results: Plasma cortisol levels were decreased during first manic episode compared to healthy controls. Higher cortisol levels were positively associated with the presence of irritability (dysphoria), while elated mania showed lower cortisol levels compared to controls.

Limitation: Data including larger samples are lacking.

Conclusion: Higher cortisol in dysphoric mania compared to predominantly elated/euphoric mania may indicate a clinical and neurobiological polymorphic phenomenon, potentially involving a higher biological sensitivity to stress in the presence of irritable mood. The present findings highlight the importance to add a dimensional approach to the traditional categorical diagnosis for future neurobiological studies in BD.

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Conflict of interest statement

Conflict of Interest

Neither the manuscript nor its data have been previously published or are currently under consideration for publication. None of the co-authors in this study have a possible conflict of interest, financial or otherwise.

Figures

Fig. 1
Fig. 1
Plasma cortisol levels (μg/dl) in first episode drug-naïve mania versus healthy controls.
Fig. 2
Fig. 2
A) Association between cortisol (μg/dl) and elevated mood (YMRS item 1) in the first episode drug-naïve mania; B) Association between cortisol (μg/dl) and irritability (YMRS item 5) in the first episode drug-naïve mania; and C) Association between elevated mood and irritability in the first episode drug-naïve mania.
See this image and copyright information in PMC

References

    1. Bradley AJ, Dinan TG. A systematic review of hypothalamic-pituitary-adrenal axis function in schizophrenia: implications for mortality. Journal of psychopharmacology (Oxford, England) 2010;24 (4 Suppl):91–118. - PubMed
    1. Bschor T, et al. Lithium augmentation in treatment-resistant depression: clinical evidence, serotonergic and endocrine mechanisms. Pharmacopsychiatry. 2003;36 (Suppl 3):S230–S234. - PubMed
    1. Carlson GA, Goodwin FK. The stages of mania. A longitudinal analysis of the manic episode. Archives of General Psychiatry. 1973;28 (2):221–228. - PubMed
    1. Cassidy F, Murry E, Forest K, Carroll BJ. Signs and symptoms of mania in pure and mixed episodes. Journal of Affective Disorders. 1998;50 (2–3):187–201. - PubMed
    1. Daban C, et al. Hypothalamic-pituitary-adrenal axis and bipolar disorder. The Psychiatric Clinics of North America. 2005;28 (2):469–480. - PubMed

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