Cortisol awakening response in PTSD treatment: Predictor or mechanism of change

PSYCHONEUROENDOCRINOLOGY

卷:118

Article

Rauch, Sheila A. M.^1,2  King, Anthony^3,4  Kim, H. Myra⁵  Powell, Corey⁵  Rajaram, Nirmala³  Venners, Margaret^3,6  Simon, Naomi M.^7,8  Hamner, Mark^9,10  Liberzon, Israel^3,4,11 

[1] Atlanta VA Healthcare Syst, 1670 Clairmont Rd, Decatur, GA 30033 USA

[2] Emory Univ, Sch Med, 12 Execut Pk,3RdFloor, Atlanta, GA 30029 USA

[3] VA Ann Arbor Healthcare Syst, 2215 Fuller Rd, Ann Arbor, MI 48105 USA

[4] Univ Michigan, Dept Psychiat, 4250 Plymouth Rd, Ann Arbor, MI 48109 USA

[5] Univ Michigan, Consulting Stat Comp & Analyt Res, 3550 Rackham,950 E Washington St, Ann Arbor, MI 48109 USA

[6] Natl Ctr PTSD, Disseminat & Training Div, 795 Willow Rd, Menlo Pk, CA 94025 USA

[7] NYU, Sch Med, Dept Psychiat, One Pk Ave,8ThFloor, New York, NY 10016 USA

[8] Massachusetts Gen Hosp, Dept Psychiat, One Bowdoin Sq,6th Floor, Boston, MA 02114 USA

[9] Ralph H Johnson VA Med Ctr, 109 Bee St, Charleston, SC 29401 USA

[10] Med Univ South Carolina, Dept Psychiat, 67 President St, Charleston, SC 29425 USA

[11] Texas A&M Hlth Sci Ctr, Dept Psychiat & Behav Sci, Bryan, TX USA

关键词: Cortisol;    PTSD;    Exposure therapy;    Sertraline;    Treatment;    DHEA;   

DOI  :  10.1016/j.psyneuen.2020.104714

来源: Elsevier

【 摘 要 】

PTSD is associated with abnormalities in hypothalamic-pituitary-adrenal (HPA) axis activity. This includes enhanced HPA axis negative feedback, attenuated cortisol awakening response, and attenuated cortisol response to personal trauma script. Whether HPA axis function predicts treatment response or treatment related symptom reduction in PTSD remains unclear. In addition, the relative effects of different treatment modalities (i.e., medication and psychotherapy) on HPA axis is unclear. To address this gap in knowledge, the PROGrESS study examined cortisol awakening response across treatment in Veterans with chronic PTSD randomized to receive Prolonged Exposure + Placebo (PE+PLB), Sertraline + PE (SERT + PE) or Sertraline + Enhanced Medication Management (SERT + EMM). Salivary cortisol awakening response (CAR) was assessed at baseline, mid-treatment (week 6 and 12), post-treatment (week 24) and follow-up (week 36 and 52). Among males at baseline, combat veterans with PTSD showed lower CAR Area Under the Curve Increase (AUCi; M = 3.15, SD = 9.57) than Combat controls (M = 7.63, SD = 9.07; p=.02), demonstrating combat veterans with PTSD have a less responsive system than combat controls. Higher PTSD severity was also related to lower CAR AUCi (r = -0.52, p=.03). When controlling for PTSD severity, higher baseline CAR AUCi was related to attenuated reduction in PTSD and lower likelihood of high treatment response over treatment (z = -2.06, p=.04).

【 授权许可】

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