Journal of Isfahan Medical School

Journal of Isfahan Medical School

Comparison of Salivary Cortisol Levels in Patients with Bipolar I Disorder and General Population: A Case-Control Study

Document Type : Original Article(s)

Authors
Sabra Mousavizadegan 1
Bita Nasrolahi 2
Mohammad Reza Sharbafchi 3
Mehrdad Norouzi 4
1 Department of Psychology, SR.C., Islamic Azad University, Tehran, Iran
2 Department of Psychology, SR.C., Islamic Azad University, Tehran, Iran.
3 Associate Professor of Psychiatry, Behavioural Sciences Research Center & Department of Psychiatry, Khorshid Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
4 Associate Professor, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
10.48305/jims.v44.i855.0388
Abstract
Background: Bipolar I disorder is associated with dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and elevated cortisol levels. This study aimed to compare salivary cortisol as a non-invasive biomarker in euthymic patients with bipolar I disorder and healthy controls.
Methods: In this case-control study conducted in Isfahan in 2024, 30 euthymic patients with bipolar I disorder (confirmed by DSM-5-TR, YMRS≤2, HDRS≤7) and 30 age-, sex-, and education-matched healthy individuals were selected via purposive sampling. Morning salivary cortisol (6–8 AM) was measured using Diametra ELISA kit (Diametra, Italy, 2024). Data were analyzed using independent t-test in SPSS version 27.
Findings: Mean salivary cortisol level in the patient group (12.84±8.11 ng/mL) was significantly higher than in the healthy group (7.30±4.33 ng/mL).
Conclusion: Elevated salivary cortisol even during euthymia indicates persistent HPA axis hyperactivity. This finding is consistent with previous studies in acute phases and suggests that cortisol dysregulation is a trait marker in bipolar disorder. Salivary cortisol can serve as a cost-effective, non-invasive biomarker for screening and monitoring of patients.

Highlights

Sabra Mousavizadegan: Google Scholar , PubMed

Bita Nasrolahi:Google Scholar , PubMed

Mohammad Reza Sharbafchi:Google Scholar , PubMed

Mehrdad Norouzi:Google Scholar , PubMed

Keywords
Bipolar Disorder, Euthymia, Cortisol, Saliva, Hypothalamic&‌ndash
Pituitary&‌ndash
Adrenal Axis (HPA)
Subjects
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Journal of Isfahan Medical School
Volume 44, Issue 855
3rd Week,May
May and June 2026
Pages 388-394

  • Receive Date 19 December 2025
  • Accept Date 25 June 2026