Can the DEX/CRH test or markers of oxidative stress distinguish work-related stress from major depressive disorder and normal controls?

Figures & data

Figure 2. Flowchart showing inclusion and exclusion of study participants with Exhaustion Disorder (ED) or Major Depressive Disorder (MDD). The healthy control cohort was historical and is therefore not shown, see text for details.

Table 1. Demographic and clinical characteristics of participants with Major Depressive Disorder (MDD), Exhaustion Disorder (ED) and Healthy Controls (HC).

	MDD (n = 30)	ED (n = 23)	HC (n = 39)	p-value
Age (Years)	39.3 (12.6)^Table Footnotea	44.0 (9.9)^Table Footnotea	30.9 (10.0)	<0.001
Sex, n (%) Male Female	15 (50%) 15 (50%)	10 (43.5%) 13 (56.5%)	20 (51.3%) 19 (48.7%)	0.83
BMI (Kg/m^2)	26.5 (5.9)	26.5 (4.8)	24,9 (4.0)	0.30
Current nicotine users, n (%)	14 (46.7%)^Table Footnotea,^b	5 (21.7%)^Table Footnotec	7 (21.8%)	0.023
Duration of current episode (months)	15.5 (3.93)	17.3 (3.8)	NA	0.33
Duration of sick leave (months)	NA	6.3 (1.8)	NA	–
Treatment (No. participants)
SSRI	6 (20%)^Table Footnoteb	0 (0%)^Table Footnotec	NA	–
SNRI	12 (40%)^Table Footnoteb	0 (0%)^Table Footnotec	NA	–
TCA	8 (27%)^Table Footnoteb	0 (0%)^Table Footnotec	NA	–
Other antidepressants	5 (17%)^Table Footnoteb	1(4%)^Table Footnotec	NA	–
Antipsychotics	14 (47%)^Table Footnoteb	0 (0%)^Table Footnotec	NA	–
Benzodiazepines	5 (17%)^Table Footnoteb	0 (0%)^Table Footnotec	NA	–
Antiepileptics and/or Lithium	6 (20%)^Table Footnoteb	0 (0%)^Table Footnotec	NA	–
Melatonin	2 (7%)	1 (4%)	NA	–
ECT treatment	11 (37%)^Table Footnoteb	0 (0%)^Table Footnotec	NA	–

Abbreviations: SSRI :selective serotonin reuptake inhibitors; SNRI: serotonin and norepinephrine reuptake inhibitors; TCA :tricyclic antidepressants; ECT: electroconvulsive therapy. Data are presented as Mean (± SD) or n (%). Data are analyzed univariate analysis of variance, using post hoc Least Significant Difference post hoc tests in case of a significant main test, or Chi-squared test, as appropriate.

^a Significantly different from HC.

^b Significantly different from ED.

^c Significantly different from MDD.

Figure 3. Time course curves of cortisol response to the DEX-CRH test in participants with major depressive disorder (MDD), Exhaustion Disorder (ED) and Healthy Controls (HC). Data points are represented as means with standard error of the mean.

Figure 1. Diagnostic Criteria for exhaustion disorder (ED) (F43.8 A) published by the National Board of Health and Welfare in Sweden.

Table 2. Measurements of plasma cortisol and ACTH in the Dexamethasone-CRH test in patients with major depressive disorder (MDD), exhaustion disorder (ED) and healthy controls (HC).

	MDD (n = 30)	ED (n = 24)	HC (n = 39)	p-value
Baseline cortisol (nmol/L)	17.00 (13.7–37.4)^Table Footnotea	15.65 (12.5–25.7)^Table Footnotea	11.02 (8.1–17.3)	0.002
Peak cortisol (nmol/L)	94.1 (31.4–179.5)	98.2 (38.0–270.0)	60.1 (21.0–115.0)	0.077
Baseline ACTH (pmol/L)	0.7 (0.7–0.84)	0.7 (0.7–0.7)	NA	0.50
Peak ACTH (pmol/L)	2.2 (1.3–6.1)	3.1 (1.1–6.6)	NA	0.89
AUCtotal cortisol (nmol/L)	8526.3 [5144.9, 13136.3]^Table Footnotea,^c	9584.2 [6035.1,14307.2]^Table Footnotea,^c	4872.9 [3361.2, 6780.9]^Table Footnotec	0.042
AUCnet cortisol (nmol/L)	4048.8 [1882.9, 7447.38]^Table Footnotec	5765.5 [2989.6, 9878.6]^Table Footnotec	3833.0 [2507.8, 5558.0]^Table Footnotec	0.53
AUCtotal ACTH (pmol/L)	283.38 [170.3, 425.1]^Table Footnoted	294.92 [175.0. 446.1]^Table Footnoteb	NA	0.90
AUCnet ACTH (pmol/L)	132.4 [66.2, 232.4]^Table Footnotec	154.73 [72.0, 284.5]^Table Footnotec	NA	0.73

Abbreviations: Baseline: concentrations measured post dexamethasone ingestion; AUCtotal: area under the concentration curve; AUCnet: AUCtotal subtracted baseline values. Data are presented as means with 95% confidence intervals () or median and interquartile range. Data are analyzed with univariate analysis of variance, using Least Significant Difference posthoc tests in case of a significant main test, or Kruskall-Wallis test, as appropriate.

^a Significantly different from HC.

^b Significantly different from ED.

^c Significantly different from MDD;

^c Back-transformed from cube root;

^d back-transformed from square root

Table 3. Psychometric measurements of Major Depressive Disorder (MDD), Exhaustion Disorder (ED) and Healthy Controls (HC) at the time of study participation.

	MDD (n = 30)	ED (n = 23)	HC (n = 39)	p-value
HDRS 17	22.9 (4.1)^a^,^b	8.7 (3.8)a^,^c	0.7 (1.0)	<0.001
HDRS 6	12.7 (2.0)^Table Footnoteb	5.1 (2.3)	NA	<0.001
BDI	30.5 (9.8)^Table Footnoteb	10.0 (5.6)	NA	<0.001
KEDS	30.9 (9.3)	28.6 (5.8)	NA	0.29
PSS	27.0 (4.9)a^,^b	18.8 (4.6)a^,^c	8.18 (4.4)	<0.001
WHO-5	17.4 (9.6)^Table Footnoteb	53.2 (11.6)	NA	<0.001
RSQ	33.3 (17.1)	30.8 (16.3)	NA	0.70

Abbreviations: HDRS 17/6 : Hamilton depression rating scale; BDI: beck depression inventory; KEDS:Karolinska exhaustion disorder scale; PSS :Cohen’s 10-item perceived stress scale; WHO-5 :The World Health Organization - Five Well-being Index; RSQ: restorative sleep questionnaire.

Data are presented as means (standard deviation Data are analyzed with univariate analysis of variance, using Least Significant Difference post hoc tests in case of a significant main test

^a Significantly different from HC.

^b Significantly different from ED.

^c Significantly different from MDD.

Table 4. Correlations between HPA-axis activity, psychometrics, and oxidative stress.

	CORT	8-oxodG	8-oxoGuo	HDRS 17	HDRS 6	BDI	KEDS	WHO-5	PSS	RSQ
CORT	–
8-oxodG	.03	–
8-oxoGuo	−.01	.49**	–
HDRS 17	.24*	−.13	−.28*	–
HDRS 6	.04	−.24	−.21	.87**	–
BDI	−.05	−.33*	−.32*	.81**	.79**	–
KEDS	−.06	−.21	−.16	.26	.10	.33*	–
WHO-5	.08	.26	.19	−.86**	−.86**	−.81**	−.36**	–
PSS	.18	−.16	−.20	.87**	.74**	.62**	.34*	−.77**	–
RSQ	.21	−.13	−.17	0.13	0.05	0.11	0.05	0.01	0.01	–

Abbreviations: CORT: AUC total for cortisol in the DEX-CRH test, 8-oxodG = 8-oxo-7,8-dihydro-2’-deoxyguanosine, 8-oxoGuo = 8-oxo-7,8-dihydroguanosine; HDRS 17/6 : Hamilton depression rating scale 17 and 6-item; BDI :beck depression inventory; KEDS : Karolinska exhaustion disorder scale; PSS: Cohen’s 10-item Perceived stress scale; WHO-5: The World Health Organization-5 Well-being Index; RSQ: restorative sleep questionnaire. Data are presented as spearman’s rho. *p< .05, **p < 0.01.