Daily hassles linked to common form of depression
New research from King’s College London supports a link between ‘daily hassles’ - day-to-day stress-inducing environmental factors - and a common form of depression. A substantial proportion of depressed people have ‘atypical’ depression, meaning that their symptoms differ from how depression is classically defined.
The study, published in Acta Psychiatrica Scandinavica, found that people with atypical depression were more likely to experience a high number of daily hassles and they had associated disruptions in short-term levels of the stress-response hormone cortisol. The researchers suggest atypical depression could be thought of as a distinct condition to classical depression, and that focusing on reducing common types of environmental factors could help patients.
‘It was interesting to observe that it was only common life circumstances rather than more unexpected and severe life events, such a car accident, which were highly associated with atypical depression, in comparison to other forms of depression,’ said lead author Dr Andrés Herane Vives, a researcher at King’s College London’s Institute of Psychiatry, Psychology & Neuroscience.
The clinical features of classical ‘melancholic’ depression include a low mood that is not changed by life circumstances. On the other hand, people with atypical depression have a ‘reactive’ low mood, meaning that if the patient receives good news or experiences a positive event, their mood can improve, albeit only temporarily. Melancholic patients also have decreased appetite and insomnia, while patients with atypical depression have increased appetite and hypersomnia – an increased number of sleeping hours.
The researchers focused on how cortisol levels are affected in people with atypical depression. Previous studies have found that while classical depression is linked with increased cortisol, atypical depression is linked with decreased short-term cortisol.
Surprisingly, despite confirming that people with atypical depression had reduced short-term levels of cortisol compared to healthy people, the study found long-term measures of cortisol were normal. This suggests that atypical depression could be characterised by a disruption in the rhythm of cortisol, say the authors.
More research is needed to determine the exact nature of the disruptions in cortisol rhythm among people with atypical depression, but the results add evidence to the idea that atypical depression has different clinical and biological underpinnings to classical depression.
People with atypical depression more commonly experienced daily hassles in comparison to healthy people, and in comparison to people with other forms of depression. The researchers suggest there may be a link between an increased number of daily hassles and disruptions in cortisol among people with atypical depression, and this should be taken into account when treating patients.
‘We believe that this research opens a new field to be investigated in the future,’ said Dr Herane Vives. ‘So far, depression has commonly been associated with a total cortisol concentration alteration. However, in this study, the combination of short- and long-term cortisol measures have suggested that the main neurobiological alteration, at least for atypical depression, may be grounded in a cortisol rhythm alteration, rather than in a total concentration alteration.’
Paper reference:
‘Short-term and long-term measures of cortisol in saliva and hair in atypical and non-atypical depression’ by Herane Vives et al, Acta Psychiatrica Scandinavica, 2018, DOI: 10.1111/acps.12852
For further media information please contact Robin Bisson, Senior Press Officer, Institute of Psychiatry, Psychology & Neuroscience, King’s College London on robin.bisson@kcl.ac.uk or 020 7848 5377.