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Alterations in Stress Reactivity After Long‐Term Treatment with Paroxetine in Women with Posttraumatic Stress Disorder
Author(s) -
VERMETTEN ERIC,
VYTHILINGAM MEENA,
SCHMAHL CHRISTIAN,
DE KLOET CARIEN,
SOUTHWICK STEVEN M.,
CHARNEY DENNIS S.,
BREMNER J. DOUGLAS
Publication year - 2006
Publication title -
annals of the new york academy of sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.712
H-Index - 248
eISSN - 1749-6632
pISSN - 0077-8923
DOI - 10.1196/annals.1364.014
Subject(s) - paroxetine , medicine , reuptake inhibitor , hydrocortisone , chronic stress , psychology , stressor , circadian rhythm , allostatic load , endocrinology , hypothalamic–pituitary–adrenal axis , posttraumatic stress , reactivity (psychology) , trier social stress test , hormone , psychiatry , fight or flight response , physiology , antidepressant , hippocampus , biochemistry , chemistry , alternative medicine , pathology , gene
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.