Depression is a common mental health challenge, affecting over 264 million people worldwide. While its roots are multifaceted, one significant player in this complex puzzle is cortisol, the body’s primary stress hormone.
Elevated cortisol levels, often a response to chronic stress, have been associated with the development and exacerbation of depressive symptoms.
In this article, we will discuss the relationship between cortisol and depression and how this hormone influences mental health. Additionally, we will provide practical stress management tips to help manage the effects of cortisol and support overall well-being.
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The Role of Cortisol in the Body
Cortisol is a steroid hormone synthesized from cholesterol and secreted from the adrenal glands. Cortisol is the body’s primary stress hormone, regulating metabolism, immune function, and inflammation.
During times of stress, the sympathetic nervous system activates the fight or flight response, which causes a cascade of physiological responses known as the hypothalamic-pituitary-adrenal axis (HPA axis).
The hypothalamus signals the adrenal glands to secrete epinephrine and cortisol from the adrenal glands to deal with the perceived threat. The secretion of cortisol provides the body with energy to support stressful circumstances (30).
Cortisol is crucial for the immune system and at healthy levels supports immunity and helps manage inflammation. If cortisol levels are elevated, it can lead to a weakened immune system and unregulated inflammation.
Cortisol increases blood sugar levels by releasing stored glucose. Chronically elevated cortisol may contribute to persistent hyperglycemia, which is a risk factor for type 2 diabetes (30).
Defining Depression
Depression is a common but serious mood disorder that can affect people of all ages, races, ethnicities, and genders. Depression affects the way individuals feel, think, sleep, eat, work, and handle daily activities. Depression can develop from long periods of stress, genetic factors, environmental toxicity, and hormonal fluctuations. Common signs and symptoms of depression include (24):
- Persistent sadness, anxiety, or feelings of “emptiness”
- Feelings of hopelessness
- Irritability or frustration
- Loss of interest or pleasure in hobbies
- Difficulty concentrating
- Difficulty sleeping
- Changes in appetite
- Physical aches and pains
- Thoughts of death or suicide
Cortisol Levels in People with Depression
Elevated levels of cortisol are associated with an increased incidence of depression. Cortisol binds to receptors all over the body. In depression, the receptors that cortisol binds to may function abnormally in response to a hypersecretion of cortisol. The severity of depression symptoms is often correlated with higher levels of cortisol.
This means individuals with longer periods of stress (higher cortisol levels) may experience more severe depression symptoms. During chronic stress, cortisol levels are initially elevated. Over time, the adrenal glands may become fatigued, leading to cortisol deficiency. Cortisol deficiency is also associated with irritability, apathy, and depression (15, 22).
How Cortisol Affects Mood
Chronically elevated cortisol levels may contribute to serotonin deficiency, which is associated with symptoms of depression. Serotonin is a neurotransmitter involved in learning, happiness, sleep, and sexual arousal. When an excess of cortisol affects serotonin production, it is common for symptoms of anxiety, insomnia, and apathy to develop.
Chronic dysregulation of the HPA axis may also contribute to the suppression of brain-derived neurotrophic factor (BDNF). BDNF plays an important role in neuron growth and is neuroprotective in times of stress and inflammation. After periods of chronic stress, decreased secretion of BDNF may result in neurodegeneration and an increased risk of depression (15).
How to Identify Cortisol-related Depression
Depression is a complex condition influenced by various factors such as genetics, life events, imbalances in brain chemistry, underlying infections, socioeconomic circumstances, relationships, and chronic stress.
To explore cortisol-related depression, healthcare practitioners may measure cortisol levels throughout the day to determine if this is a contributing factor to a patient's depression. The following are different methods for measuring cortisol:
- Blood Tests: A blood test can measure a patient’s cortisol level; however, it only provides a snapshot of the particular time the blood was taken.
- Saliva Tests: Saliva tests, such as the Adrenocortex Stress Profile by Genova Diagnostics, measure cortisol levels throughout the day. This test involves taking four saliva samples throughout the day, providing a more detailed picture of cortisol fluctuations.
- Urine Tests: The concentration of free circulating cortisol correlates with urinary cortisol levels, resulting in urinary tests being the most sensitive for examining cortisol throughout the day. The Adrenal Corticoids Profile by Doctor’s Data can be used to monitor cortisol and other hormone metabolites involved in the HPA axis.
Approaches to Managing Cortisol-related Depression
Managing cortisol-related depression may involve the following approaches:
- Herbal support for cortisol balance: Including herbs such as Withania somnifera (Ashwagandha), Rhodiola rosea (Rhodiola), Passiflora incarnata (Passionflower), and Lavandula angustifolia (Lavender) may help support the body's response to stress. Dosages should be individualized based on medical history and concurrent prescribed medications.
- Dietary Changes: Consider increasing intake of omega-3 fatty acids, antioxidants, and magnesium.
- B-Vitamins: Supplementing with Vitamin B3 (Niacin), B6 (Pyridoxine), and B12 (Cobalamin) may help support brain function and neurotransmitter synthesis. It's important to consult with a healthcare professional before starting any new supplement or vitamin regimen.
- Vitamin B3 (Niacin): Recommended dosage is typically 14-16 mg per day. It may help improve circulation and the production of serotonin, a neurotransmitter associated with mood regulation.
- Vitamin B6 (Pyridoxine): Suggested dosage ranges from 1.3-1.7 mg daily for adults, but therapeutic doses can be higher, around 20-50 mg per day, under medical supervision. It plays a crucial role in the synthesis of neurotransmitters such as serotonin and dopamine.
- Vitamin B12 (Cobalamin): Recommended daily intake is 2.4 mcg for adults, but higher doses of 500 mcg to 1,000 mcg may be used in supplementation, particularly for those with deficiencies. Vitamin B12 is essential for maintaining healthy nerve cells and producing mood-regulating neurotransmitters.
- L-Theanine: an amino acid known for its stress-reducing properties by modulating neurotransmitter activity in the brain. It may promote relaxation and improve sleep quality by increasing the levels of calming neurotransmitters like GABA, serotonin, and dopamine. Dosage: The typical recommended dose of L-Theanine ranges from 100 to 200 mg per day. For stress reduction and relaxation, 200 mg taken once or twice daily is commonly suggested. For improving sleep quality, taking 200 mg around 30 to 60 minutes before bedtime can be effective.
- Medication therapy when needed: Tricyclic antidepressants, SSRIs, and SNRIs are all medical options that a physician may discuss with patients. (6, 16, 26)
Effective Stress Management Techniques
Incorporating stress management techniques into everyday life can be beneficial in managing cortisol-related depression. The following are recommendations to ease stress:
- Yoga and Meditation: Practicing yoga and meditation regularly may help lower cortisol levels, promote relaxation, and improve overall mental health. These practices enhance mindfulness, reduce anxiety, and foster a sense of inner peace.
- Reach Out for Help: Seeking support from trusted family, friends, or a trained counselor for talk therapy can provide emotional relief and practical strategies for managing stress. Talking about your feelings helps you process emotions and gain perspective.
- Focus on Improving Sleep Quality: Prioritizing good sleep hygiene by maintaining a regular sleep schedule, creating a restful environment, and avoiding stimulants before bed can significantly reduce stress and improve mood.
- Music Therapy: Listening to or creating music can be a helpful tool for stress relief. Music therapy may help lower cortisol levels, elevate mood, and provide a healthy outlet for emotional expression.
- Nature Therapy: Spending time in nature, whether through walking, hiking or simply sitting in a park, can greatly reduce stress and improve mental well-being. Nature therapy helps ground individuals, providing a calming and restorative effect on the mind and body.
Preventative Strategies
Early detection of cortisol balance is important because it allows for timely intervention and management of potential health issues. In the early stages of cortisol imbalance, natural interventions may be more efficient in stabilizing hormone levels. Over long periods, the risk of developing weight gain, heart disease, neurodegenerative disease, and more severe depression symptoms may increase (18).
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Key Takeaways
- Cortisol plays a vital role in modulating stress, metabolism, and immune response
- Chronic stress and cortisol imbalance may increase the risk of developing depression
- Cortisol measurements using saliva or urine tests can be included in the workup for depression
- Implementing herbal support, dietary changes, and stress management techniques may be helpful in the prevention and management of cortisol-related depression
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