HYPOTHALAMIC-PITUITARY-ADRENAL AXIS ACTIVITY IN PANIC DISORDER - PREDICTION OF LONG-TERM OUTCOME BY PRETREATMENT CORTISOL-LEVELS

Objective: The authors sought to determine whether hypothalamic-pituit ary-adrenal (HPA) axis activity in patients before their treatment for panic disorder can predict follow-up functional status. Although base line HPA axis disturbances in patients with panic disorder appear to a ttenuate with treatment, there is evidence that they may be linked to poorer long-term outcomes. Method: Follow-up clinical data were obtain ed for 18 of 20 patients with panic disorder who participated in a det ailed study of HPA axis activity in panic, both before and during thei r treatment with alprazolam. HPA axis assessment included monitoring o f adrenocorticotropin and cortisol over a full circadian cycle. The re lationships between disability and clinical status at 2-year follow-up and HPA axis overactivity at entry were examined. Results: Mean 24-ho ur cortisol levels before treatment provided a strong, positive predic tor of disability scores at follow-up. Those patients who achieved the treatment goal of medication-free remissions had less evidence of HPA axis overactivity at entry than those who were not in remission. Conc lusions: HPA axis activity before treatment did predict outcome 2 year s later. This relationship appears robust and reproducible. Further wo rk is needed to define the neuroendocrine mechanisms underlying the HP A axis markers that are linked to long-term functioning and to determi ne the biological, psychological, and social processes that link HPA a xis disturbance to poorer outcomes.