title: Salivary cortisol levels in persons with and without different anxiety disorders.
abstract: OBJECTIVE
  To examine the association between several subtypes of anxiety disorders and various cortisol indicators in a large cohort study. Anxiety disorders have been suggested to be linked to hypothalamic-pituitary-adrenal (HPA) axis activity, although results are scarce and inconsistent. No earlier studies have examined consistency of HPA axis findings across several anxiety subtypes and whether associations are state or trait dependent.
  
  
  METHODS
  Data are derived from 1427 participants of the Netherlands Study of Depression and Anxiety. Three groups were compared: 342 control participants without psychiatric disorders; 311 persons with a remitted (no current) anxiety disorder (social phobia, generalized anxiety disorder, panic disorder); and 774 persons with a current anxiety disorder, as diagnosed using the Composite International Diagnostic Interview psychiatric interview. Cortisol levels were measured in seven saliva samples, determining the 1-hour cortisol awakening response, evening cortisol, and cortisol response after 0.5 mg of dexamethasone ingestion.
  
  
  RESULTS
  Current anxiety disorder was associated with higher awakening cortisol levels (p = .002). These findings were mainly present for patients with panic disorder with agoraphobia and anxious patients with comorbid depressive disorder. Remitted anxiety only showed a trend toward higher morning cortisol (p = .08). No associations were observed for anxiety status and evening cortisol level or cortisol suppression after dexamethasone.
  
  
  CONCLUSIONS
  This study showed a modest but significantly higher 1-hour cortisol awakening response among anxiety patients, which was driven by those with panic disorder with agoraphobia and those with comorbid depression.
authors.affiliation: Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands. s.vreeburg@ggzingeest.nl
authors.forename: Sophie A
authors.initials: SA
authors.lastname: Vreeburg
authors.forename: Frans G
authors.initials: FG
authors.lastname: Zitman
authors.forename: Johannes
authors.initials: J
authors.lastname: van Pelt
authors.forename: Roel H
authors.initials: RH
authors.lastname: Derijk
authors.forename: Jolanda C M
authors.initials: JC
authors.lastname: Verhagen
authors.forename: Richard
authors.initials: R
authors.lastname: van Dyck
authors.forename: Witte J G
authors.initials: WJ
authors.lastname: Hoogendijk
authors.forename: Johannes H
authors.initials: JH
authors.lastname: Smit
authors.forename: Brenda W J H
authors.initials: BW
authors.lastname: Penninx
mesh_terms: D000328:Adult; D000379:Agoraphobia / Q000175:diagnosis / Q000378:metabolism; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000378:metabolism; D002940:Circadian Rhythm / Q000502:physiology; D003865:Major Depressive Disorder / Q000097:blood / Q000175:diagnosis / Q000378:metabolism; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis* / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000175:diagnosis / Q000378:metabolism; D010555:Personality Inventory; D010698:Phobic Disorders / Q000175:diagnosis / Q000378:metabolism; D010913:Pituitary-Adrenal System / Q000503:physiopathology; D012463:Saliva / Q000737:chemistry*; D012621:Seasons
chemical_list: D006854:Hydrocortisone