Am J Psychiatry 1996; 153:69-73
Copyright © 1996 by American Psychiatric Association
Hypothalamic-pituitary-adrenal axis activity in panic disorder: prediction of long-term outcome by pretreatment cortisol levels
JL Abelson and GC Curtis
Department of Psychiatry, University of Michigan, Ann Arbor, USA.
OBJECTIVE: The authors sought to determine whether hypothalamic-
pituitary-adrenal (HPA) axis activity in patients before their treatment
for panic disorder can predict follow-up functional status. Although
baseline HPA axis disturbances in patients with panic disorder appear to
attenuate with treatment, there is evidence that they may be linked to
poorer long-term outcomes. METHOD: Follow-up clinical data were obtained
for 18 of 20 patients with panic disorder who participated in a detailed
study of HPA axis activity in panic, both before and during their treatment
with alprazolam. HPA axis assessment included monitoring of
adrenocorticotropin and cortisol over a full circadian cycle. The
relationships between disability and clinical status at 2-year follow-up
and HPA axis overactivity at entry were examined. RESULTS: Mean 24-hour
cortisol levels before treatment provided a strong, positive predictor of
disability scores at follow- up. Those patients who achieved the treatment
goal of medication-free remissions had less evidence of HPA axis
overactivity at entry than those who were not in remission. CONCLUSIONS:
HPA axis activity before treatment did predict outcome 2 years later. This
relationship appears robust and reproducible. Further work is needed to
define the neuroendocrine mechanisms underlying the HPA axis markers that
are linked to long-term functioning and to determine the biological,
psychological, and social processes that link HPA axis disturbance to
poorer outcomes.
