Allostasis and allostatic load: Implications for neuropsychopharmacology

The primary hormonal mediators of the stress response, glucocorticoids and catecholamines, have both protective and damaging effects art the body. III the short run, they are essential for adaptation, maintenance of homeostas is, and survival (allostasis). Yet, over longer time intervals, they exact a cost (allostatic fond) that can accelerate disease processes. The concept s of allostasis and allostatic fond center around the brain ns interpreter and responder to environmental challenges and ns a target of those challeng es. in anxiety disorders, depressive illness, hostile and aggressive states /substance abuse, and post-traumatic stress disorder (PTSD), allostatic len d takes the form of chemical imbalances ns well ns perturbations in the diu rnal rhythm, and, in some cases, atrophy of brain structures. IIE addition, growing evidence indicates that depressive illness and hostility are both associated with cardiovascular disease (CVD) and other systemic disorders. A major risk factor far these conditions is early childhood experiences of abuse and neglect that increase allostatic lend later in life and lead indi viduals into social isolation, hostility, depression, and conditions like e xtreme obesity and CVD. Animal models support the notion of lifelong influe nces of early experience on stress hormone reactivity. Whereas, depression and childhood abuse and neglect tend to he more prevalent in individuals nt the lower end of the socioeconomic ladder, cardiovascular and other diseas es follow a gradient across the full range of socioeconomic status (SES): A I I SES gradient is also evident for measures of allostatic load. Wide-rang ing SES gradient have also beer? described for substance abuse and affectiv e anxiety disorders as a function of education. These aspects are discussed ns important, emerging public health issues where the brain plays cr key r ole. (C) 1999 American College of Neuropsychopharmacology. Published hy Els evier Science Inc.