Elevated Cortisol in Older Adults With Generalized Anxiety Disorder Is Reduced by Treatment: A Placebo-Controlled Evaluation of Escitalopram

被引:92
|
作者
Lenze, Eric J. [1 ]
Mantella, Rose C. [3 ]
Shi, Peichang
Goate, Alison M.
Nowotny, Petra
Butters, Meryl A. [4 ]
Andreescu, Carmen [4 ]
Thompson, Paul A. [2 ]
Rollman, Bruce L. [5 ]
机构
[1] Washington Univ, Sch Med, Dept Psychiat, St Louis, MO 63110 USA
[2] Washington Univ, Methodol & Data Anal Ctr, Sanford Res Univ S Dakota, St Louis, MO 63110 USA
[3] Univ Pittsburgh, Abbott Labs, Pittsburgh, PA 15260 USA
[4] Univ Pittsburgh, Dept Psychiat, Pittsburgh, PA 15260 USA
[5] Univ Pittsburgh, Ctr Res Hlth Care, Div Gen Internal Med, Pittsburgh, PA 15260 USA
来源
基金
美国国家卫生研究院;
关键词
Anxiety; cortisol; aging; health; stress; antidepressant; ADRENAL AXIS RESPONSE; LATE-LIFE; SALIVARY CORTISOL; PREFRONTAL CORTEX; 5-HTTLPR POLYMORPHISM; HIPPOCAMPAL VOLUME; STRESS; DEMENTIA; ASSOCIATION; DEPRESSION;
D O I
10.1097/JGP.0b013e3181ec806c
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
Background: Generalized anxiety disorder (GAD) is a common disorder in older adults, which has been linked to hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis in this age group. The authors examined whether treatment of GAD in older adults with a selective serotonin reuptake inhibitor (SSRI) corrects this HPA axis hyperactivity. Methods: The authors examined adults aged 60 years and older with GAD in a 12-week randomized controlled trial comparing the SSRI escitalopram with placebo. The authors collected salivary cortisol at six daily time points for 2 consecutive days to assess peak and total (area under the curve) cortisol, both at baseline and posttreatment. Results: Compared with placebo-treated patients, SSRI-treated patients had a significantly greater reduction in both peak and total cortisol. This reduction in cortisol was limited to patients with elevated (above the median) baseline cortisol, in whom SSRI-treated patients showed substantially greater reduction in cortisol than did placebo-treated patients. Reductions in cortisol were associated with improvements in anxiety. Additionally, genetic variability at the serotonin transporter promoter predicted cortisol changes. Conclusions: SSRI treatment of GAD in older adults reduces HPA axis hyperactivity. Further research should determine whether these treatment-attributable changes are sustained and beneficial. (Am J Geriatr Psychiatry 2011; 19:482-490)
引用
收藏
页码:482 / 490
页数:9
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