HYPOTHALAMIC-PITUITARY-ADRENAL AXIS ACTIVITY IN PANIC DISORDER - EFFECTS OF ALPRAZOLAM ON 24 H SECRETION OF ADRENOCORTICOTROPIN AND CORTISOL

Pre-clinical and some clinical evidence suggests that central overdriv e within the hypothalamic-pituitary-adrenal (HPA) axis may play a role in panic disorder, and that the anti-panic efficacy of alprazolam may involve its ability to inhibit this drive. Detailed examination of 24 h secretion of adrenocorticotropin (ACTH) and cortisol in 20 panic pa tients had revealed subtle HPA axis abnormalities prior to treatment. In order to determine whether these abnormalities resolve with alprazo lam therapy, these patients were re-studied over a full circadian cycl e after 12 weeks on alprazolam. Alprazolam produced substantial improv ement in clinical status which was accompanied by nearly full resoluti on of pre-treatment hypercortisolemia. The impact of treatment on ACTH was more complex and influenced by symptom severity. The results are consistent with the hypotheses that HPA axis regulation is subtly dist urbed in panic disorder and that impact on the HPA axis may play a rol e in alprazolam's mechanism of efficacy. Copyright (C) 1996 Elsevier S cience Ltd.