Blunted cortisol response to awakening in mild to moderate depression: Regulatory influences of sleep patterns and social contacts

Cortisol is elevated during severe depression. However, some studies of outpatients suggest reduced cortisol levels, either basal or poststress. More definite evidence of this phenomenon is needed, and correlates that may explain the disparate findings should be identified. Women from the community (37 depressed and 36 nondepressed) completed electronic diaries in order to help researchers assess the cortisol awakening response (CAR), sleep, and social contacts. Depressed women had a blunted CAR compared with nondepressed women. Among the nondepressed but not among depressed women, time of waking, and number of social contacts (especially positive ones) were independently associated with CAR. These psychosocial factors may contribute to a normal CAR, but their regulatory influence may become disrupted during mild to moderate clinical depression.