Jl. Abelson et al., HYPOTHALAMIC-PITUITARY-ADRENAL AXIS ACTIVITY IN PANIC DISORDER - EFFECTS OF ALPRAZOLAM ON 24 H SECRETION OF ADRENOCORTICOTROPIN AND CORTISOL, Journal of Psychiatric Research, 30(2), 1996, pp. 79-93
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.