Elevated cortisol in older adults with generalized anxiety disorder is reduced by treatment: A placebo-controlled evaluation of escitalopram

Eric J. Lenze, Rose C. Mantella, Peichang Shi, Alison M. Goate, Petra Nowotny, Meryl A. Butters, Carmen Andreescu, Paul A. Thompson, Bruce L. Rollman

Research output: Contribution to journalArticlepeer-review

81 Scopus citations

Abstract

Background: Generalized anxiety disorder (GAD) is a common disorder in older adults, which has been linked to hyperactivity of the hypothalamic- pituitary-adrenal (HPA) axis in this age group. The authors examined whether treatment of GAD in older adults with a selective serotonin reuptake inhibitor (SSRI) corrects this HPA axis hyperactivity. Methods: The authors examined adults aged 60 years and older with GAD in a 12-week randomized controlled trial comparing the SSRI escitalopram with placebo. The authors collected salivary cortisol at six daily time points for 2 consecutive days to assess peak and total (area under the curve) cortisol, both at baseline and posttreatment. Results: Compared with placebo-treated patients, SSRI-treated patients had a significantly greater reduction in both peak and total cortisol. This reduction in cortisol was limited to patients with elevated (above the median) baseline cortisol, in whom SSRI-treated patients showed substantially greater reduction in cortisol than did placebo-treated patients. Reductions in cortisol were associated with improvements in anxiety. Additionally, genetic variability at the serotonin transporter promoter predicted cortisol changes. Conclusions: SSRI treatment of GAD in older adults reduces HPA axis hyperactivity. Further research should determine whether these treatment-attributable changes are sustained and beneficial.

Original languageEnglish
Pages (from-to)482-490
Number of pages9
JournalAmerican Journal of Geriatric Psychiatry
Volume19
Issue number5
DOIs
StatePublished - May 2011

Keywords

  • Anxiety
  • aging
  • antidepressant
  • cortisol
  • health
  • stress

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