Abstract
A recent study reported that daily hassles were associated with increased secretion of cortisol in depressed patients [1]. Another study found that stressful daily events were associated with increased cortisol secretion in healthy volunteers [2]. Mood appeared to play a mediating role in the relationship between hassles and cortisol secretion. Negative affectivity is not just a confounding variable, but is related to elevated cortisol secretion during normal daily activities.
Multiple lines of evidence suggest that cortisol is involved in the pathophysiology of major depression [3, 4]. Cortisol affects mood, cognition and behaviour. Cortisol acts on brain cells and alters the availability of brain neurotransmitters. Excessive cortisol damages the control mechanisms in the brain that modulate secretion of corticotropin-releasing hormone (CRH) and hence, adrenocorticotropic hormone (ACTH) and adrenal cortisol. This may lead to chronic disinhibition of the hypothalamic-pituitary-adrenocortical axis (HPA). Glucocorticoids impair hippocampal morphology and lead to cognitive impairment [4]. Cortisol administration to healthy volunteers alters processes associated with prefrontal cortex functions, such as inhibitory control, attention regulation and planning [4]. Other observations also support an important role of cortisol in the development of depression. In general, there has been a shift from viewing excessive HPA activity in depression as an epiphenomenon to its having specific effects on cognition and symptom formation.
Depression is associated with an increase in mortality, independent of suicide [4, 5]. For example, major depression is an independent risk factor for the development of coronary artery disease and osteoporosis. Elevated cortisol may mediate the effects of depression on endocrine, metabolic, proinflammatory and haemostatic factors that increase vulnerability to cardiovascular disease and other medical conditions. Antiglucocorticoid therapies for depression may reduce the medical consequences of depression associated with hypercortisolemia.
In summary, it appears that daily hassles may increase cortisol levels and, consequently, negatively affect psychological and physical health of both healthy and depressed persons. The most difficult question: how to avoid daily hassles?