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The Effect of Comorbid Depression and Sexual Abuse during Childhood on Glucocorticoid and Mineralocorticoid Receptor Sensitivity of Patients with Post-Traumatic Stress Disorder

Marcelo F. Mello, Andrea F. Mello, Juliana E. Ruiz, Jose Paulo Fiks, Sergio B. Andreoli, Rodrigo A. Bressan, Mariana C. P. Costa, Jair J. Mari, Deborah Suchecki and Mario Juruena

Evidence shows that Posttraumatic Stress Disorder (PTSD) patients have low basal cortisol levels and
Glucocorticoid-Receptor (GR) super sensitivity following a pharmacological challenge. These findings, however, are controversial, partially due to the presence of confounding factors such as comorbidity with Major Depressive Disorder (MDD) and childhood trauma. In the present study, salivary cortisol levels of victims of violence with and without PTSD were assessed following a Prednisolone Suppression Test (PST), controlling for the presence of MDD and sexual abuse during childhood. The sample was nested in an epidemiological study performed in the city of São Paulo. Subjects with a diagnosis of PTSD  (PTSD+) and a matched control group (PTSD-) were submitted to the Structured Clinical Interview for DSM-IV, after which the Early Trauma Inventory (ETI), Clinician-Administered PTSD Scale (CAPS), Beck
Depression (BDI) and Anxiety Inventory (BAI) and Peri-traumatic Dissociative Experiences Questionnaire (PDEQ) were used. A saliva sample was collected before and after 5 mg of prednisolone was  administered at 10 PM. Of the 34 PTSD+ patients, 19 had MDD comorbidity (PTSD+MDD). The cortisol curve of PTSD+MDD patients was similar to that of controls, and both were higher than that of PTSD patients. Cortisol levels after awakening after prednisolone administration were negatively correlated with the CAPS, BAI, and sexual abuse score on the ETI. These findings not only reinforce the idea that PTSD patients have GR super sensitivity, they also reveal that factors such as sexual abuse during childhood and comorbid MDD should be considered when studying HPA-axis reactivity, given their significant impact on the stress response.