HPA axis regulation in posttraumatic stress disorder: A meta-analysis focusing on potential moderators

Neuroscience and Biobehavioral Reviews
Sarah SchumacherChristine Knaevelsrud

Abstract

Posttraumatic stress disorder (PTSD) is often associated with alterations in the hypothalamic-pituitary-adrenal (HPA) axis. Previous findings are inconsistent, possibly due to trauma exposure of controls or different hormone measurement methods. We investigated cortisol, dehydroepiandrosterone (DHEA) and its sulfate (DHEA-S) in adults with clinical PTSD under basal or challenged conditions (Prospero registration no. CRD42016041690). A search of PubMed, Scopus, Medline, PsycINFO, Pilots/ProQuest, and Web of Science resulted in 108 included studies (N = 6484). Morning and 24 h cortisol were significantly lower in PTSD than in controls (g = -0.21; 95% CI: -0.42-(-0.01); g = -0.31; CI: -0.60-(-0.03)). Significant cortisol increases occurred after awakening in PTSD (g = 0.40; CI: 0.13-0.67) and in non-exposed controls (g = 0.96; CI: 0.59-1.33). Evening DHEA was significantly higher in PTSD than in non-exposed controls (g = 0.58; CI: 0.17-0.99). All groups showed large cortisol suppression effects after dexamethasone administration. Overall, the potential moderators investigated did not reveal a consistent pattern of HPA alterations.

Citations

Feb 6, 2020·Stress : the International Journal on the Biology of Stress·Leigh Luella van den HeuvelSoraya Seedat
Mar 15, 2020·Cognitive, Affective & Behavioral Neuroscience·Maria M QuinonesKathi Heffner
Jul 1, 2020·International Journal of Molecular Sciences·Sabah NisarMohammad Haris
Dec 14, 2019·Psychophysiology·Brigitte S Rockstroh, Lisa M McTeague
Feb 25, 2021·Psychoneuroendocrinology·Oswald D KothgassnerMercedes M Huscsava
May 11, 2021·European Journal of Psychotraumatology·Charlotte E HilberdinkSusanne R de Rooij
Jun 29, 2021·Psychoneuroendocrinology·Katrin V HummelSusann Steudte-Schmiedgen
Aug 7, 2021·Neurobiology of Stress·Seyma Katrinli, Alicia K Smith

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