Cortisol and Hippocampal Volume as Predictors of Active Suicidal Behavior in Major Depressive Disorder: Case Report

Abstract

Background: Suicide is frequently encountered in patients suffering from major depressive disorder (MDD). Since only a third of treated depressed patients are able to achieve remission, in the last few years, new theories have been proposed to better understand the mechanism of this illness. Our paper analyzes the interrelation between cortisol as a marker of neuroendocrine theory as a response to stress, and hippocampal volume subfields in depression as a marker of neurogenesis and neuroplasticity theory. Case Report: Here we present the case of a 52-yearold male patient with known history of MDD, who died as a result of completed suicide by hanging. The patient had been recently discharged from a psychiatric clinic, after being hospitalized for a major depressive episode (MDE). The result of the autopsy, medical records, laboratory analysis and a magnetic resonance image (MRI) of the patient were analyzed. Both the right and left volumes of the hippocampus were found to be smaller when compared to normal values reported in the literature. The morning level of cortisol was higher than the normal value. Conclusion: In a depressed patient with an acute stressful event, high levels of cortisol associated with decreased volume of the hippocampus could represent predictors for an increased risk of suicide.

Keywords

• Cortisol, hippocampal volume, suicide

References

1. 1. Serafini G. Neuroplasticity and major depression, the role of modern antidepressant drugs. World J Psychiatry 2012;2:49-57. [CrossRef]
2. 2. Duric V, Banasr M, Stockmeier C, Simen A, Newton SS, Overholser JC, et al. Altered expression of synapse and glutamate related genes in post-mortem hippocampus of depressed subjects. Int J Neuropsychopharmacol 2013;16:69-82. [CrossRef]
3. 3. Fuchsova B, Alvarez Juliá A, Rizavi HS, Frasch AC, Pandey GN. Altered expression of neuroplasticity-related genes in the brain of depressed suicides. Neuroscience 2015;299:1-17.[CrossRef]
4. 4. Gorgulu Y, Caliyurt O. Rapid antidepressant effects of sleep deprivation therapy correlates with serum BDNF changes in major depression. Brain Res Bull 2009;80:158-62. [CrossRef]
5. 5. FreeSurfer (The General Hospital Corporation, Boston MA, USA (“MGH”)). FreeSurfer Software 2013 Retrieved May 20 2015, Available from http://surfer.nmr.mgh.harvard.edu/
6. 6. Tae WS, Kim SS, Lee KU, Nam EC, Kim KW. Validation of hippocampal volumes measured using a manual method and two automated methods (FreeSurfer and IBASPM) in chronic major depressive disorder. Neuroradiology 2008;50:569-81. [CrossRef]
7. 7. Walhovd KB, Fjell AM, Reinvang I, Lundervold A, Dale AM, Eilertsen DE, et al. Effects of age on volumes of cortex, white matter and subcortical structures. Neurobiol Aging 2005;26:1261-70. [CrossRef]
8. 8. Maletic V, Robinson M, Oakes T, Iyengar S, Ball SG, Russell J. Neurobiology of depression: an integrated view of key findings. Int J Clin Pract 2007;61:2030-40. [CrossRef]

9. 9. Cowen PJ. Cortisol, serotonin and depression: all stressed out? Br J Psychiatry 2002;180:99-100. [CrossRef]
10. 10. Holsboer F, Ising M. Stress hormone regulation: biological role and translation into therapy. Annu Rev Psychol 2010;61:81-109. [CrossRef]