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The hypothalamic-pituitary-adrenal axis in PTSD: Pathophysiology and treatment interventions
Abstract
ABSTRACT Questions of how altered functioning of the hypothalamic pituitary adrenal (HPA) axis contribute to the development and maintenance of posttraumatic stress disorder (PTSD) have been the focus of extensive animal and human research. As a rule, results have been inconsistent across studies, likely due to a variety of confounding variables that have received inadequate attention. Important confounding factors include the effects of early life stress, biological sex, and the glucocorticoid used for interventions. In this manuscript we review: 1) the literature on identified abnormalities of HPA axis function in PTSD, both in terms of basal functioning and as part of challenge paradigms; 2) the role of HPA axis function pre‐ and immediately post‐trauma as a risk factor for PTSD development; 3) the impact of HPA axis genes’ allelic variants and epigenetic modifications on PTSD risk; 4) the contributions of HPA axis components to fear learning and extinction; and 5) therapeutic manipulations of the HPA axis to both prevent and treat PTSD, including the role of glucocorticoids as part of medication enhanced psychotherapy. HIGHLIGHTSThe inconsistencies in HPA axis associations with PTSD likely derive from methodological differences.Effects of the HPA axis alteration may differ across the symptom clusters of PTSD.Dexamethasone and hydrocortisone should not be considered equivalent glucocorticoids in PTSD research.Hydrocortisone given to prevent PTSD following a trauma is the best supported HPA axis intervention for PTSD.Future studies of the HPA axis in PTSD must control for early life stress and biological sex.
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Result
Metadata
- Authors
- Dunlop, B. W., & Wong, A.
- Venue
- Progress in Neuro-Psychopharmacology and Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2019-03
- Volume
- 89
- Pages
- 361-379
- ISSN
- 0278-5846 (ISSN-L)
- OpenAlex
- W2896729901
- Cited by
- 242
- References
- 69
- FWCI
- 17.97
- Type
- journal article
- Language
- en
- Open access
- closed
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