Background: The hypothalamic-pituitary-adrenal (HPA) axis has been implicated in the aetiopathology of depression, and the incidence of HPA dysfunction tends to increase with the severity of treatment resistance. In healthy volunteers (HV), both acute and chronic hypercortisolaemia causes cognitive impairment, including emotional memory. The exact mechanism of this remains unclear; however the action of cortisol on corticosteroid receptors in the hippocampus appears to be crucial and this may also be important in the aetiopathology of depression. The aim of this thesis was to investigate acute and chronic states of the HPA axis, and its role on neurocognition in HV and treatment resistant depression (TRD). Methods: The acute action of cortisol in HV was examined through meta-analysis of the literature. In HV, the acute, non-genomic effects of hydrocortisone on the hippocampus were measured using pharmacological challenge functional magnetic resonance imaging (phMRI) and the effects on the working memory n-back task during functional magnetic resonance imaging (fMRI). Additionally, the neurocognitive effects in TRD patients, who are theorised to have chronically elevated corticosteroids, were compared to age and sex matched HV using the n-back task and a novel emotional encoding-retrieval task. Finally the acute effects of hydrocortisone on the whole brain were measured in TRD compared to HV using phMRI.Results: Meta-analysis results demonstrated an adverse effect on performance in retrieval tasks, but not encoding, after an acute rise in cortisol in HV, with a trend towards sparing of emotional memories. Using phMRI, hydrocortisone caused a time dependent increase in signal in the hippocampus, as well as an increased signal in the ventrolateral prefrontal cortex and a decreased signal in the hippocampus during the n-back task. Patients with TRD, when compared with HV, had a decreased signal in the dorsolateral prefrontal cortex during the n-back task. Additionally, during the emotional encoding-retrieval task, regardless of the emotional content, the patients showed a decrease in signal in the posterior cingulate during encoding and an increase in the posterior insula during retrieval. During retrieval of positive versus neutral images, there was an increase in signal in the anterior cingulate. The earlier phMRI findings were not reproduced in either the TRD or age and sex matched controls.Conclusions: This work developed and examined a new technique to explore the relationship between the HPA axis and depression, as well as exploring the neurocognitive difference between TRD and HV. A non-genomic, acute effect of cortisol on the hippocampus was demonstrated in HV, as well as differences in processing emotional memories both acutely in HV and also in TRD patients. Further work needs to be done to develop the phMRI technique further and explore the aetiopathological role of the HPA axis in depression, focussing on the hippocampus.
|Date of Award||1 Aug 2014|
- The University of Manchester
|Supervisor||Ian Anderson (Supervisor), Bill Deakin (Supervisor) & Shane Mckie (Supervisor)|
- working memory
- emotional memory
- Treatment resistant depression