title: Dexamethasone-suppressed cortisol awakening response predicts treatment outcome in posttraumatic stress disorder.
abstract: BACKGROUND
  Posttraumatic stress disorder (PTSD) has been associated with several alterations in the neuroendocrine system, including enhanced cortisol suppression in response to the dexamethasone suppression test. The aim of this study was to examine whether specific biomarkers of PTSD predict treatment success in trauma-focused psychotherapy.
  
  
  METHODS
  Data were collected in the context of a randomized controlled trial comparing two forms of trauma-focused psychotherapy. Basal cortisol and dehydroepiandrosterone sulfate levels, and the response to the dexamethasone suppression test were assessed pre-treatment in 24 PTSD patients. Treatment success was measured by pre- to post-treatment decrease in self-reported PTSD severity.
  
  
  RESULTS
  A more suppressed cortisol curve after dexamethasone significantly predicted greater PTSD symptom decrease in trauma-focused psychotherapy, independent of the effects of gender, pre-treatment PTSD symptom severity, and trauma history. Basal early morning cortisol and dehydroepiandrosterone sulfate did not predict treatment response.
  
  
  CONCLUSIONS
  The number of participants who completed the neuroendocrine measurements was small and a significant number of participants fulfilled criteria of co-morbid major depressive disorder.
  
  
  CONCLUSIONS
  This study suggests the use of the dexamethasone-suppression test for the cortisol awakening response as a biomarker for treatment response to trauma-focused psychotherapy. Measures of HPA-axis sensitivity appear to be an important predictor of positive clinical response in PTSD patients, and may lead to biomarker-based treatment matching in the future.
authors.affiliation: Department of Psychiatry, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands; Arq Psychotrauma Expert Group, Diemen, The Netherlands. Electronic address: m.j.nijdam@amc.uva.nl.
authors.forename: M J
authors.initials: MJ
authors.lastname: Nijdam
authors.affiliation: Department of Psychiatry, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: J G C
authors.initials: JG
authors.lastname: van Amsterdam
authors.affiliation: Department of Psychiatry, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands; Arq Psychotrauma Expert Group, Diemen, The Netherlands.
authors.forename: B P R
authors.initials: BP
authors.lastname: Gersons
authors.affiliation: Department of Psychiatry, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands; Arq Psychotrauma Expert Group, Diemen, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Olff
mesh_terms: D000328:Adult; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D003907:Dexamethasone / Q000494:pharmacology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011613:Psychotherapy / Q000379:methods*; D012463:Saliva / Q000378:metabolism; D012737:Sex Factors; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology* / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D019314:Dehydroepiandrosterone Sulfate; D003907:Dexamethasone; D006854:Hydrocortisone
keywords: Cortisol; Dehydroepiandrosterone sulfate; Low-dose dexamethasone suppression test; Posttraumatic stress disorder; Trauma-focused psychotherapy; Treatment response