Elsevier

Psychoneuroendocrinology

Volume 31, Issue 2, February 2006, Pages 250-255
Psychoneuroendocrinology

Cortisol levels and depression in men and women using heroin and cocaine

https://doi.org/10.1016/j.psyneuen.2005.08.002Get rights and content

Summary

Abnormalities in the hypothalamic-pituitary-adrenal (HPA) axis are well documented in men using illicit drugs and/or infected with HIV; however, less is known about HPA function, or the health consequence of HPA dysfunction, in their female counterparts. People with depression exhibit hypercortisolemia, and depression is common in people with HIV or substance use problems. The current study investigated cortisol secretion in 209 demographically matched men and women, stratified by their HIV and drug use status. Self-reported depressive symptoms were evaluated using a standardized, validated questionnaire (CES-D). Women reported more depressive symptoms than men (p=.01). Male and female drug users exhibited higher cortisol concentrations (p=.03), and were more likely to report depressive symptoms (p=.04), than non-users. Depression was related to elevated cortisol concentrations for the study population (p=.03), and women with elevated cortisol concentrations were significantly more depressed than all other participants (p=.05). While it is unknown whether high cortisol concentrations precede depressive symptoms or vice versa, these data indicate that higher cortisol concentrations are associated with depressive symptoms in heroin and cocaine users, and that this association is more pronounced in women than men. HIV status did not act in an additive or synergistic way with drug use for either cortisol or CES-D measures in the current study. Unique therapies to treat the endocrine and mental health consequences of illicit drug use in men and women deserve consideration as depressive symptoms, and high cortisol concentrations associated with depressive symptoms, differ by gender.

Section snippets

Study population

The Study of HIV, Injection Drug Use, Nutrition and Endocrinology (SHINE) was a cross-sectional evaluation of volunteers recruited in Baltimore, designed to investigate the effects of HIV and drug use on multiple endocrine and metabolic variables, body composition, and quality of life. Participants were recruited into the study from 2001 to 2004 by the following categories: (1) no illicit drug use in the past 3 years; (2) current methadone maintenance; (3) occasional drug use (<3 times/week in

Participant characteristics

A total of 209 participants, after excluding the outliers, were categorized according to their gender, drug use and HIV status (Table 1a, Table 1b). The majority of study participants were African American. Age (mean=43.4 years for men, 42.2 years for women) and education (24% men and 25% women completed at least 12 years of schooling) did not differ by gender (ps>.05). A majority of the study population reported heavy drug use, and among those 65 (42%) reported administering their drugs via

Discussion

Gender, illicit drug use and HIV status may all impact cortisol concentrations and mood. We observed greater basal cortisol production among illicit drug users regardless of their gender or HIV status. There are a number of possible explanations for this result. Because we recruited from a community-based population of illicit drug users, it is possible that many of the active users were experiencing withdrawal symptoms during study participation. Hypercortisolism is a known consequence of

Acknowledgements

We thank Vickie Sinkler and Rosa Sebree for their help in recruiting participants and collecting data. This work was supported by grants 1R01DA/DKR814-6141 and 1R01DA14098 from the NIH. Portions of this work were presented at the 86th Annual Meeting of the Endocrine Society, 2004, New Orleans, LA.

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