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Examination of peripheral basal and reactive cortisol levels in major depressive disorder and the burnout syndrome: A systematic review


Rothe, Nicole; Steffen, J; Penz, Marlene; Kirschbaum, Clemens; Walther, Andreas (2020). Examination of peripheral basal and reactive cortisol levels in major depressive disorder and the burnout syndrome: A systematic review. Neuroscience and Biobehavioral Reviews, 114:232-270.

Abstract

It is debated as to whether major depressive disorder (MDD) and the burnout syndrome represent different aspects of the same syndrome or whether they reflect separate entities. A dysregulation of the hypothalamus-pituitary-adrenal-axis has been related to both conditions separately. Dissecting the pathophysiology of the conditions and describing differences and similarities with regard to stress physiological systems might further clarify whether underlying etiological models of these syndromes differ. A systematic literature search including MDD and the burnout syndrome and peripheral cortisol measures was performed and resulted in 190 studies for inclusion in the qualitative synthesis. For MDD, findings suggest a general state of hypercortisolism and glucocorticoid resistance reflected by increased basal cortisol levels, reduced reactivity to psychosocial stress and a reduced cortisol suppression in pharmacological challenge tests. For the burnout syndrome, two central factors limit further conclusions: i) there is not a sufficient amount of studies examining the burnout syndrome and different cortisol secretion patterns to provide an evidence base, ii) the burnout syndrome is assessed heterogeneously reflecting imprecision of the measured constructs. Large prospective cohort studies examining both conditions in parallel rigorously controlling for confounders are required to further elucidate the differences and similarities of the HPA axis in MDD and the burnout syndrome.

Abstract

It is debated as to whether major depressive disorder (MDD) and the burnout syndrome represent different aspects of the same syndrome or whether they reflect separate entities. A dysregulation of the hypothalamus-pituitary-adrenal-axis has been related to both conditions separately. Dissecting the pathophysiology of the conditions and describing differences and similarities with regard to stress physiological systems might further clarify whether underlying etiological models of these syndromes differ. A systematic literature search including MDD and the burnout syndrome and peripheral cortisol measures was performed and resulted in 190 studies for inclusion in the qualitative synthesis. For MDD, findings suggest a general state of hypercortisolism and glucocorticoid resistance reflected by increased basal cortisol levels, reduced reactivity to psychosocial stress and a reduced cortisol suppression in pharmacological challenge tests. For the burnout syndrome, two central factors limit further conclusions: i) there is not a sufficient amount of studies examining the burnout syndrome and different cortisol secretion patterns to provide an evidence base, ii) the burnout syndrome is assessed heterogeneously reflecting imprecision of the measured constructs. Large prospective cohort studies examining both conditions in parallel rigorously controlling for confounders are required to further elucidate the differences and similarities of the HPA axis in MDD and the burnout syndrome.

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Additional indexing

Item Type:Journal Article, refereed, further contribution
Communities & Collections:06 Faculty of Arts > Institute of Psychology
Dewey Decimal Classification:150 Psychology
Scopus Subject Areas:Social Sciences & Humanities > Neuropsychology and Physiological Psychology
Life Sciences > Cognitive Neuroscience
Life Sciences > Behavioral Neuroscience
Uncontrolled Keywords:Behavioral Neuroscience, Cognitive Neuroscience, Neuropsychology and Physiological Psychology
Language:English
Date:1 July 2020
Deposited On:25 Nov 2022 14:45
Last Modified:28 Apr 2024 01:39
Publisher:Elsevier
ISSN:0149-7634
OA Status:Closed
Publisher DOI:https://doi.org/10.1016/j.neubiorev.2020.02.024