title: Elevated alpha-amylase but not cortisol in generalized social anxiety disorder.
abstract: Stress-system dysregulation is thought to increase the risk for anxiety disorders. Here we describe both hypothalamic pituitary adrenal (HPA) axis and autonomic nervous system (ANS) activity in basal non-challenging conditions and after 0.5mg dexamethasone in generalized social anxiety disorder (gSAD) patients. To ensure stress-free sampling we collected saliva and determined cortisol and alpha-amylase (sAA), the latter a relative new marker of autonomic activity. Forty-three untreated gSAD patients without comorbidity were compared with 43 age and gender matched controls in non-stressed conditions on sAA and cortisol after awakening, during the day (including late evening), and after a low dose (0.5mg) of dexamethasone. Cortisol and sAA were analyzed with mixed models. Additional analyses were done with paired t-tests. Apart from the assessments in the morning, gSAD patients had significantly higher diurnal and post-dexamethasone 1600h sAA levels. No differences between gSAD and controls in any cortisol measurements were found. In conclusion, in gSAD in basal, non-stimulated conditions and after dexamethasone, we found hyperactivity of the ANS, as measured with sAA, but not of the HPA-axis. This suggests a relative increased activity of the ANS as compared to the HPA-axis, in line with the observed hyperarousal in gSAD.
authors.affiliation: Department of Psychiatry, Leiden University Medical Center, 2300 RC Leiden, The Netherlands. j.f.van_veen@lumc.nl
authors.forename: J F
authors.initials: JF
authors.lastname: van Veen
authors.forename: I M
authors.initials: IM
authors.lastname: van Vliet
authors.forename: R H
authors.initials: RH
authors.lastname: Derijk
authors.forename: J
authors.initials: J
authors.lastname: van Pelt
authors.forename: B
authors.initials: B
authors.lastname: Mertens
authors.forename: F G
authors.initials: FG
authors.lastname: Zitman