Major depression, cognitive function and cortisol

Our knowledge of the relationships between depression, cortisol levels and daily cortisol profiles, and cognitive impairment in a long-term perspective is scant. We aim to study these relationships over two years in patients with MDD diveded in to subgrou ps of patients with a first time episode, with recurrent episodes and with bipolar depression. The possible effects of MDD on cognitive functioning as well as structural and functional abnormalities have important clinical implications in patients every day and occupational life in the acute phase of illness and in a long-term perspective. Although successful antidepressant treatment is associated with a normalisation of cortisol levels, the longer term effects on cognitive function may represent a new stressor to the recovered patient, and lead to higher risk of symptom recurrence. The normal life functioning of the recovered patient will, we hypothesise, be impaired, leading to frustration, low self esteem, low coping, and further stress. That is, t he cortisol-induced cognitive impairment will sensitise the recovered patient to stress-induced relapse in the face of events that would not normally induce a depressive state. This will increase the risk of relapse, associated with the failure to cope with normal life events. Thus high levels of cortisol, together with cognitive impairments, may act as markers for risk of relapse which may be used in a clinical setting. The main purpose of this project is to study the relationships between levels of cortisol in depressed patients and cognitive impairments, during acute depressive episodes, remission phases, and periods of symptom recurrence over a two year period. In particular, our interest lies in whether the cognitive impairments and high cortisol levels often associated with depression will be clinically predictive of relapse following remission