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Bipolar patients with low levels of the stress hormone cortisol are twice as likely to be depressed than those with higher levels of the hormone.

Swedish researchers also linked low cortisol levels to a significantly higher risk of poor quality of life.

"In bipolar depression the stress system is often activated, which means that the affected individuals have elevated cortisol levels in the blood. We have now been able to show that both over- and underactivity in the stress system, with corresponding elevated or reduced cortisol levels, can impair mental health in terms of depression and poor quality of life in these patients," Martin Maripuu, a PhD student at the Department of Clinical Sciences, Psychiatry Unit Umeå University and physician at the psychiatric clinic, Östersund Hospital, said in a news release.

The latest study involved 145 patients who had bipolar disorder, as well as 145 people in a control group.

The findings revealed that more than half of bipolar patients who had lower or elevated levels of cortisol also had depression.

Furthermore having low quality of life was six times more common in patients with low cortisol levels and nearly five times more common among those with high cortisol levels. Researchers compared these patients with others who exhibited normal activity in the stress system.

 "These are important results that in the future could contribute to a more personally tailored medical treatment of bipolar disorder. The results may also ultimately lead to the development of new drugs that work by normalizing the stress system and cortisol levels," Maripuu said in a news release.

The findings were published in the journal PLOS ONE.