Declaration of interest
Many patients with depressive disorders demonstrate resistance to psychological therapy. A frequent finding is hypothalamic–pituitary–adrenal (HPA) axis alterations. As cortisol is known to modulate cognitive processes, those patients may be less likely to profit from psychological therapy.
To conduct a systematic review and meta-analysis on cortisol as a predictor of psychological therapy response.
The Cochrane Library, EMBASE, MEDLINE and PsycINFO databases were searched. Records were included if they looked at patients with any depressive disorder engaging in psychological therapy, with a pre-treatment cortisol and a post-treatment symptom measure.
Eight articles satisfied our selection criteria. The higher the cortisol levels before starting psychological therapy, the more symptoms patients with depression experienced at the end of treatment and/or the smaller their symptom change.
Our findings suggest that patients with depression with elevated HPA functioning are less responsive to psychological therapy.
S.F. acknowledges funding by the Swiss National Science Foundation. R.S. is supported by the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre. A.H.V. is funded by the Comision Nacional de Investigacion Cientifica y Tecnologica and the Psychiatric Research Trust. A.J.C. is supported by the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King's College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.
- © The Royal College of Psychiatrists 2017.
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