Serial Measures of the Cortisol Awakening Response during Treatment for Depression in an Inpatient Setting

Goal: To determine whether the Cortisol Awakening Response (CAR) associates with treatment response and course in hospital for inpatients with major depressive disorder (MDD). Methods: The CAR was measured at admission and discharge in patients completing a four-week inpatient program for MDD. Self-report questionnaires were used to assess changes in depression, anxiety, and perceived stress. Results: Over the four week hospital stay measures of CAR reactivity (Delta, AUCi) decreased, but there was no significant correlation between the change in CAR reactivity and change in clinical symptoms. Cross-sectional measurements of the CAR reactivity at both admission and discharge were strongly correlated with the drop in depression scores in hospital. Furthermore, poor treatment responders had a significantly lower CAR reactivity at both admission and discharge than did good responders. Conclusion: Individuals with higher CAR reactivity at admission and discharge had the greatest reduction in depression over the course of treatment.MAS