Effects of trauma exposure on the cortisol response to dexamethasone administration in PTSD and major depressive disorder.
OBJECTIVE
To evaluate cortisol suppression following 0.5 mg of dexamethasone (DEX) in trauma survivors (N=52) with posttraumatic stress disorder (PTSD), major depressive disorder (MDD), both, or neither disorder, and in subjects never exposed to trauma (N=10), in order to examine interactions between diagnosis and trauma history on cortisol negative feedback inhibition.


METHODS
Lifetime trauma exposure and psychiatric diagnoses were assessed and blood samples were obtained at 8:00 a.m. for the determination of baseline cortisol. Participants ingested 0.5 mg of DEX at 11:00 p.m. and blood samples for determination of cortisol and DEX were obtained at 8:00 a.m. the following day.


RESULTS
PTSD was associated with enhanced cortisol suppression in response to DEX. Among trauma survivors, the presence of a traumatic event prior to the "focal" trauma had a substantial impact on cortisol suppression in subjects with MDD. Such subjects were more likely to show cortisol alterations similar to those associated with PTSD, whereas subjects with MDD with no prior trauma were more likely to show alterations in the opposite direction, i.e. relative non-suppression.


CONCLUSIONS
Cortisol hypersuppression in PTSD appears not to be dependent on the presence of traumatic events prior to the focal trauma. However, prior trauma exposure may affect cortisol suppression in MDD. This finding may have implications for understanding why only some depressed patients show non-suppression on the DST.
Yehuda
Rachel
R
The Traumatic Stress Studies Program, Department of Psychiatry, Mount Sinai School of Medicine and Bronx Veterans Affairs, Bronx VAMC, OOMH PTSD-116/A, 130 West Kingsbridge Road, Bronx, NY 10468, USA. rachel.yehuda@med.va.gov
Halligan
Sarah L
SL
Golier
Julia A
JA
Grossman
Robert
R
Bierer
Linda M
LM
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D003130:Combat Disorders / Q000097:blood / Q000523:psychology; D003864:Depression, Chemical; D003865:Major Depressive Disorder / Q000097:blood* / Q000150:complications / Q000175:diagnosis*; D003907:Dexamethasone; D025461:Feedback, Physiological; D005260:Female; D005938:Glucocorticoids; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008016:Life Change Events; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D013313:Stress Disorders, Post-Traumatic / Q000097:blood* / Q000150:complications / Q000175:diagnosis*; D013315:Stress, Psychological / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D014947:Wounds and Injuries / Q000097:blood / Q000150:complications / Q000523:psychology
D005938:Glucocorticoids; D003907:Dexamethasone; D006854:Hydrocortisone