Salivary cortisol in panic attacks

Objective: Documentation of hypothalamic-pituitary-adrenal (HPA) axis distu rbance in panic disorder has been inconsistent. Increased cortisol levels h ave been associated with altered HPA function due to stress. The authors ex amined salivary cortisol levels in spontaneously occurring, unprovoked pani c attacks. Method: Patients with panic disorder (N = 25) collected saliva s amples when panic attacks occurred. Levels of cortisol in the saliva sample s were determined and were compared with levels in comparison samples of sa liva obtained 24 hours after the panic attack occurred. Results: During spo ntaneous panic attacks there was a subtle but significant elevation of cort isol levels, compared with levels obtained 24 hours later. No significant c orrelations were found between the cortisol elevations during panic attacks and the severity of the attack as measured by using the Acute Panic Invent ory or the severity of illness as measured by using the Panic and Agoraphob ia Scale. Conclusions: Saliva sampling may be a useful method for investiga ting neuroendocrine parameters during spontaneously occurring panic attacks .