Advances in Understanding Neuroendocrine Alterations in PTSD and Their Therapeutic Implications



    1. Division of Traumatic stress studies, Mount Sinai School of Medicine, New York, New York 10029, USA and James J. Peters Veterans Affairs Medical Center, Bronx, New York 10468, USA
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Address for correspondence: Rachel Yehuda, Ph.D., Bronx VA OOMH, 130 West Kingsbridge Road, Bronx, NY 10468. Voice: 718-584-9000; ext.: 6964; fax: 718-741-4775.


Abstract: The findings from investigations of the neuroendocrinology of posttraumatic stress disorder (PTSD) have highlighted alterations that have not historically been associated with pathologic processes, and have, accordingly, raised several questions about the nature of the findings and their relationship to PTSD. The most infamous of these observations-–low cortisol levels-–has been the subject of much discussion and scrutiny because the finding has been both counterintuitive, and not uniformly reproducible. This fact notwithstanding, novel therapeutic approaches to the treatment of PTSD are in large part predicated on the assumption that glucocorticoid levels may be lower in PTSD. This article summarizes important neuroendocrine observations in cortisol and provides strategies for understanding what has emerged over the past two decades, to be a complex and sometimes contradictory literature.