title: Alterations in stress reactivity after long-term treatment with paroxetine in women with posttraumatic stress disorder.
abstract: Posttraumatic stress disorder (PTSD) is typically accompanied by both acute and chronic alterations in the stress response. These alterations have mostly been described in individuals under baseline conditions, but studies have also used a challenge model to assess the role of the hypothalamic-pituitary-adrenal (HPA) axis in the stress response. The purpose of this article was to assess the effect of long-term treatment with the selective reuptake inhibitor (SSRI), paroxetine, on stress reactivity in patients with PTSD. We assessed diurnal salivary cortisol and urinary cortisol as well as cortisol, heart rate, and behavioral responses to a standardized cognitive stress challenge, in 13 female patients with chronic PTSD before and after 12 months of paroxetine treatment. Treatment resulted in a significant decrease in PTSD symptoms. Twenty-four-hour urinary cortisol was lower compared to base line after successful treatment. Treatment resulted in a decrease of salivary cortisol levels on all time points on a diurnal curve. Despite similar stress perception, cortisol response to the cognitive stress challenge resulted in a 26.5% relative decrease in stress-induced salivary cortisol with treatment. These results suggest that successful treatment with SSRI in chronic PTSD is associated with a trend for a decrease in baseline diurnal cortisol and with reduced cortisol reactivity to stress.
authors.affiliation: Rudolf Magnus Institute of Neurosciences, Department Psychiatry, University Medical Center, Int mailbox B01206, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. e.vermetten@umcutrecht.nl
authors.forename: Eric
authors.initials: E
authors.lastname: Vermetten
authors.forename: Meena
authors.initials: M
authors.lastname: Vythilingam
authors.forename: Christian
authors.initials: C
authors.lastname: Schmahl
authors.forename: Carien
authors.initials: C
authors.lastname: DE Kloet
authors.forename: Steven M
authors.initials: SM
authors.lastname: Southwick
authors.forename: Dennis S
authors.initials: DS
authors.lastname: Charney
authors.forename: J Douglas
authors.initials: JD
authors.lastname: Bremner
mesh_terms: D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D001794:Blood Pressure / Q000502:physiology; D003627:Data Interpretation, Statistical; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism / Q000652:urine; D017374:Paroxetine / Q000627:therapeutic use*; D011569:Psychiatric Status Rating Scales; D012463:Saliva / Q000378:metabolism; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy* / Q000503:physiopathology*; D013315:Stress, Psychological / Q000378:metabolism / Q000503:physiopathology*
chemical_list: D018687:Antidepressive Agents, Second-Generation; D017374:Paroxetine; D006854:Hydrocortisone