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 control group.
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, healthy individuals, with same age, sex, andeducatin level, 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.
Findings: Mean salivary cortisol level in the case group (12.84 ± 8.11 ng/mL) was significantly higher than in the control 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 considerable marker in bipolar disorder. Salivary cortisol can serve as a cost-effective, non-invasive biomarker for screening and monitoring 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