Clinical Psychopharmacology and Neuroscience 2019; 17(4): 487-494  
The Interaction of Oxytocin and Social Support, Loneliness, and Cortisol Level in Major Depression
Tsung-Yu Tsai1,*, Huai-Hsuan Tseng1,2,*, Mei Hung Chi1, Hui Hua Chang3,4,5,6, Cheng-Kuan Wu1, Yen Kuang Yang1,2,7, Po See Chen1,2,8
Departments of 1Psychiatry and 5Pharmacy, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 2Institute of Behavioral Medicine, 3Institute of Clinical Pharmacy and Pharmaceutical Sciences, and 4School of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Departments of 6Pharmacy and 7Psychiatry, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, 8Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
Correspondence to: Po See Chen
Department of Psychiatry, National Cheng Kung University Hospital, 138 Sheng Li Road, North Dist., Tainan 70403, Taiwan
E-mail: chenps@mail.ncku.edu.tw
ORCID: https://orcid.org/0000-0003-4963-578X
*These authors contributed equally to this study.
Received: December 26, 2018; Revised: March 11, 2019; Accepted: April 4, 2019; Published online: November 30, 2019.
© The Korean College of Neuropsychopharmacology. All rights reserved.

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Abstract
Objective: Loneliness is a specific risk factor for depressive symptoms and suicidal behavior. The present study examined whether the serum oxytocin level would interact with social support and buffers loneliness and hypothalamic-pituitary-adrenal (HPA)-axis activity in drug-naïve patients with major depressive disorder (MDD).
Methods: Twenty-six patients with MDD (male:female = 3:23; mean age, 45.54 ± 12.97 years) were recruited. The 17-item Hamilton Depression Rating Scale, UCLA Loneliness Scale and self-reported Measurement of Support Function Questionnaire were administered. Serum oxytocin and cortisol levels were assessed using a commercial immunoassay kits.
Results: In MDD patients, a negative association was found between degrees of social support and loneliness (β= −0.39, p = 0.04). The interaction between social support and serum oxytocin level was negatively associated with loneliness (β= −0.50, p = 0.017) and serum cortisol level (β= −0.55, p = 0.020) after adjusting for age. Follow-up analyses showed that the association between higher social support and lower loneliness was observed only in the higher-oxytocin group (r = −0.75, p = 0.003) but not in the lower group (r = −0.19, p = 0.53). The significance remained after further adjusting for sex and depression severity.
Conclusion: Low oxytocin level is a vulnerability factor for the buffering effect of social support for loneliness and aberrant HPA-axis activity in MDD patients.
Keywords: Cortisol; Loneliness; Major depressive disorder; Oxytocin; Social support.


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