Allostasis and allostatic load: Implications for neuropsychopharmacology

The primary hormonal mediators of the stress response, glucocorticoids and catecholamines, have both protective and damaging effects art the body. III the short run, they are essential for adaptation, maintenance of homeostasis, and survival (allostasis). Yet, over longer time intervals, they exact a cost (allostatic fond) that can accelerate disease processes. The concepts of allostasis and allostatic fond center around the brain ns interpreter and responder to environmental challenges and ns a target of those challenges. in anxiety disorders, depressive illness, hostile and aggressive states/substance abuse, and post-traumatic stress disorder (PTSD), allostatic lend takes the form of chemical imbalances ns well ns perturbations in the diurnal rhythm, and, in some cases, atrophy of brain structures. IIE addition, growing evidence indicates that depressive illness and hostility are both associated with cardiovascular disease (CVD) and other systemic disorders. A major risk factor far these conditions is early childhood experiences of abuse and neglect that increase allostatic lend later in life and lead individuals into social isolation, hostility, depression, and conditions like extreme obesity and CVD. Animal models support the notion of lifelong influences of early experience on stress hormone reactivity. Whereas, depression and childhood abuse and neglect tend to he more prevalent in individuals nt the lower end of the socioeconomic ladder, cardiovascular and other diseases follow a gradient across the full range of socioeconomic status (SES): AI I SES gradient is also evident for measures of allostatic load. Wide-ranging SES gradient have also beer? described for substance abuse and affective anxiety disorders as a function of education. These aspects are discussed ns important, emerging public health issues where the brain plays cr key role. (C) 1999 American College of Neuropsychopharmacology. Published hy Elsevier Science Inc.