平衡皮质醇：在一项针对重度抑郁症的随机对照试验中，情感调节和多模式运动作为药物治疗的辅助作用

IF 2.6 3区医学 Q2 PSYCHIATRY

Mental Health and Physical Activity Pub Date : 2025-05-16 DOI:10.1016/j.mhpa.2025.100687

Vagner Deuel de O. Tavares , Geovan Menezes de Sousa , Felipe B. Schuch , Joseph Firth , Lin Yang , Maria Stein , Bruno Marson Malagodi , Raissa Nóbrega , Renali Camilo Bezerra , Alexandre Guimarães Gouveia , Jaime Eduardo Hallak , Emerson Arcoverde , Colleen Cuthbert , Nicole Leite Galvão-Coelho

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引用次数: 0

摘要

背景：运动对重度抑郁症（MDD）患者皮质醇水平的辅助作用尚不明确。因此，我们的目的是比较单独药物治疗（抗抑郁药）与药物治疗加运动的辅助干预在12周内皮质醇水平的变化。方法分别在治疗前（基线- 0）、治疗期间（第5-t1周）和治疗结束时（第12-t2周）评估血清皮质醇。运动干预的重点是在整个多模式运动过程中促进感知努力、享受和整体愉悦。这项研究招募了59名成年人，并将他们随机分为两组：运动组；N = 26，女性76.9%，平均年龄28.5岁；正常皮质醇- EG-CN， n= 18，高皮质醇血症- EG-HC， n= 7)和对照组（CG, n= 29,72.40%女性，平均年龄26.0岁/正常皮质醇- cn， n= 17，高皮质醇血症- CO-HC， n= 11）。结果两组（EG组和CO组）皮质醇水平均未随时间变化。然而，在亚组分析中，无论干预分配如何，高皮质醇血症参与者的皮质醇水平都降低了。在研究结束时，EG高皮质醇MDD患者的皮质醇水平与正常皮质醇组（EG- cn）相似[p= .507,d= - 0.22(-1.11,.67)]，而接受独家药物治疗的高皮质醇MDD患者（对照组）的皮质醇水平继续显著高于CO-CN [p=<]。0001年,d =−2.32(-3.41,-1.20)]。结论：我们的初步研究结果表明，在重度抑郁症和高皮质醇血症患者中，有组织的、多模式的、影响调节的、有监督的锻炼计划以及药物治疗使皮质醇水平正常化。尽管如此，药物治疗和运动加药物治疗都不能改变基线皮质醇水平正常的患者的皮质醇水平。这些结果表明，运动与药物治疗相结合可能有效降低皮质醇水平，特别是在重度抑郁症和皮质醇升高的个体中。然而，需要更大样本的进一步研究来更彻底地探索这种反应。

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Balancing Cortisol: The role of affect-adjusted and multimodal exercise as an adjunct to pharmacotherapy in a randomized controlled trial for major depressive disorder

Background

The adjunctive effects of exercise on cortisol levels in people with major depressive disorders (MDD) are equivocal. Therefore, we aimed to compare pharmacotherapy alone (antidepressants) versus an adjunct intervention of pharmacotherapy plus exercise on cortisol levels over 12 weeks.

Methods

Serum cortisol were assessed before (baseline–t0), during (Week 5–t1), and at the end of treatment (Week 12–t2). The exercise intervention focused on promoting perceived effort, enjoyment, and overall pleasure throughout the multimodal exercise sessions. The study enrolled 59 adults and randomly allocated them into two groups: exercise group (EG; n= 26,76.9% females, mean age 28.5 years; normal cortisol- EG-CN, n= 18 and hypercortisolemia- EG-HC, n = 7) and control group (CG, n= 29,72.40% females, mean age 26.0 years/normal cortisol CO-CN, n= 17 and hypercortisolemia- CO-HC, n= 11).

Results

No changes in cortisol levels were observed over time in both groups (EG and CO). However, in subgroup analysis, participants with hypercortisolemia reduced their cortisol levels regardless of the intervention allocation. At the end of the study, hypercortisolemic MDD participants of EG showed similar cortisol levels with those of the normal cortisol group (EG-CN) [p= .507,d= −.22(-1.11,.67)], while hypercortisolemic MDD participants under exclusive pharmacotherapy (control group) continued to show significantly higher levels than CO-CN [p=<.0001,d= −2.32(-3.41,-1.20)].

Conclusion

Our preliminary findings suggest that, in people with MDD and hypercortisolemia, a structured, multimodal, affect-adjusted, and supervised exercise program along with pharmacotherapy normalized cortisol levels. Notwithstanding, neither pharmacotherapy nor exercise plus pharmacotherapy changed cortisol levels among those with normal cortisol levels at baseline. These results indicate that combining exercise with pharmacotherapy may be effective in reducing cortisol levels specifically in individuals with MDD and elevated cortisol. However, further studies with larger samples are needed to explore this response more thoroughly.

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来源期刊

Mental Health and Physical Activity PSYCHIATRY-

CiteScore

6.70

自引率

6.40%

发文量

审稿时长

32 days

期刊介绍： The aims of Mental Health and Physical Activity will be: (1) to foster the inter-disciplinary development and understanding of the mental health and physical activity field; (2) to develop research designs and methods to advance our understanding; (3) to promote the publication of high quality research on the effects of physical activity (interventions and a single session) on a wide range of dimensions of mental health and psychological well-being (eg, depression, anxiety and stress responses, mood, cognitive functioning and neurological disorders, such as dementia, self-esteem and related constructs, psychological aspects of quality of life among people with physical and mental illness, sleep, addictive disorders, eating disorders), from both efficacy and effectiveness trials;