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Baseline and acute changes in the HPA system in patients with anxiety disorders: the current state of research

Author(s): Jens Plag, Sarah Schumacher,Ulrike Schmid,Andreas Strohle

Research into the role of the HPA system in mental disorders has recently increased. It has been found that hormones involved in regulation of the HPA system play an important role in stress-related disorders. In the past, baseline alterations were mainly inspected in patients with anxiety disorders. In order to assess changes concerning the acute stress reaction in these subjects, many studies also applied stress protocols such as pharmacological or nonpharmacological challenges. This review aims to provide an overview of the results regarding HPA function in various anxiety disorders, such as panic disorder, generalized anxiety disorder, social anxiety disorder, specific phobia, obsessive-compulsive disorder and post-traumatic stress disorder. A PubMed-based literature search revealed 59 studies that met the inclusion criteria (i.e., double-blind randomized placebo-controlled trial; diagnosis based on DSM‑III or ‑IV; and appropriate sample size – n ≥ 20 in the verum group). Results are presented and integrated with regard to baseline HPA system activation and response to a challenge. Markers of interest reporting on HPA system functioning were cortisol and adrenocorticotropic hormone. In addition, suggested explanations regarding pathophysiological mechanisms underlying these findings are discussed. The majority of current data do not point to an alteration of the HPA system in anxiety disorders. There is some evidence for an association between the magnitude of mental stress and a change in cortisol levels. Nevertheless, pharmacotherapeutical interventions affecting stress hormones might be promising, not only in augmentation of psychotherapy in a specific phobia, but also for secondary prevention in post-traumatic stress disorder.


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