background Patients with generalised social anxiety disorder (gsad) appear to have a hyper responsive hypothalamic-pituitary-adrenal axis (hpa-axis) following a stress challenge as compared to healthy controls. However, in basal conditions, the few studies that have been conducted so far are inconclusive about its role in gsad.
aim To report on two other levels of hpa-axis activity: the 'cortisol awakening rise' (car) and the negative feedback using the low 'dexamethasone suppression test' (dst, 0.5 mg).
method Basal hpa-axis functioning was tested in 43 gsad patients before and after 5 months treatment with citalopram. Salivary cortisol levels were measured after awakening, during the day (11.00, 15.00, 19.00 and 22.00 h) and after a low dose of dexamethasone at 23.00 h (9.00 and 16.00 h). Sample collection was performed during two test days at home.
results In the awakening curve (car) and in the diurnal cortisol levels, no statistical differences were found before and after treatment. After the dst however, gsad patients had significantly lower cortisol levels after treatment with citalopram than before.
conclusion These data suggest that the negative feedback of the hpa-axis is different in gsad after treatment with citalopram.