Association between cortisol awakening response and memory function in major depression

K. Hinkelmann*, C. Muhtz, L. Dettenborn, A. Agorastos, S. Moritz, K. Wingenfeld, C. Spitzer, S. M. Gold, K. Wiedemann, C. Otte

*Corresponding author for this work

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19 Citations (Scopus)


Background While impaired memory and altered cortisol secretion are characteristic features of major depression, much less is known regarding the impact of antidepressant medication. We examined whether the cortisol awakening response (CAR) is increased in depressed patients with and without medication compared with healthy controls (HC) and whether CAR is associated with memory function in each group. Method We examined 21 patients with major depression without medication, 20 depressed patients on antidepressant treatment, and 41 age-, sex-and education-matched healthy subjects. We tested verbal (Auditory Verbal Learning Task) and visuospatial (Rey figure) memory and measured CAR on two consecutive days. Results Patient groups did not differ in severity of depression. We found a significant effect of group (p = 0.03) for CAR. Unmedicated patients exhibited a greater CAR compared with medicated patients (p = 0.04) with no differences between patient groups and HC. We found a significant effect of group for verbal (p = 0.03) and non-verbal memory (p = 0.04). Unmedicated patients performed worse compared with medicated patients and HC in both memory domains. Medicated patients and HC did not differ. Regression analyses revealed a negative association between CAR and memory function in depressed patients, but not in HC. Conclusions While in unmedicated depressed patients the magnitude of CAR is associated with impaired memory, medicated patients showed a smaller CAR and unimpaired cognitive function compared with HC. Our findings are compatible with the idea that antidepressants reduce CAR and partially restore memory function even if depressive psychopathology is still present.

Original languageEnglish
Pages (from-to)2255-2263
Number of pages9
JournalPsychological Medicine
Issue number11
Publication statusPublished - 2013
Externally publishedYes


  • Awakening response
  • Cognitive function
  • Cortisol
  • Depression
  • Hypothalamus-pituitary-adrenal axis
  • Neuropsychology

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    Hinkelmann, K., Muhtz, C., Dettenborn, L., Agorastos, A., Moritz, S., Wingenfeld, K., ... Otte, C. (2013). Association between cortisol awakening response and memory function in major depression. Psychological Medicine, 43(11), 2255-2263.