An exploratory study of salivary cortisol changes during chamomile extract therapy of moderate to severe generalized anxiety disorder.
An exploratory study of salivary cortisol changes during chamomile extract therapy of moderate to severe generalized anxiety disorder.
复制标题
洋甘菊提取物治疗中度至重度广泛性焦虑症期间唾液皮质醇变化的探索性研究。
DOI：
10.1016/j.jpsychires.2017.10.011
复制
发表时间：
2018
影响因子：
4.8
通讯作者：
Mao,JunJ
中科院分区：
文献类型：
--
作者：
Keefe,JohnR;Guo,Wensheng;Li,QingS;Amsterdam,JayD;Mao,JunJ
目的应激生物学中的功能障碍被认为是焦虑症的致病因素，并在成功的治疗过程中得到改善，但支持这一假说的临床数据有限。我们评估了广泛性焦虑症(GAD)患者早上皮质醇和日间皮质醇斜率的增加是否与洋甘菊治疗的临床反应有关。方法在45名在甘菊开放标签临床试验中诊断为GAD的DSM-IV患者中，在治疗前和治疗后的上午8点、下午12点、下午4点和晚上8点对唾液皮质醇进行了为期3天的评估混合模型分析评估GAD症状变化是否能预测治疗期间皮质醇水平变化的程度。结果治疗期间症状的改善与治疗前后皮质醇水平的变化显著相关。症状改善较多的受试者早晨唾液皮质醇显著增加(β=0.48，p<；0.001)，而皮质醇从早上到当天其余时间的下降幅度更大(β=0.55，p<；0.001)。此外，基线时较低的皮质醇水平(β=0.24，p=0.003)和清晨皮质醇的较小下降(−=0.30，p=0.003)与症状的改善有关。结论早上唾液皮质醇的增加和白天皮质醇的斜率与甘菊治疗广泛性焦虑症的症状改善有关。对广泛性焦虑症的治疗反应可能部分源于应激生物功能障碍的正常化，但进一步的工作涉及建立样本内的异常，排除混杂(例如，睡眠)，以及安慰剂对照，以得出改善效果。注册codeNCT01072344.URLhttps://clinicaltrials.gov/ct2/show/NCT01072344.
ObjectivesDysfunctions in stress biology are hypothesized to contribute to anxiety disorders, and to be ameliorated during successful treatment, but limited clinical data exist to support this hypothesis. We evaluated whether increases in morning cortisol and the diurnal cortisol slope, markers of stress biology, are associated with clinical response to chamomile therapy among subjects with generalized anxiety disorder (GAD).MethodsAmong 45 subjects with DSM-IV diagnosed GAD in an open-label clinical trial of chamomile, salivary cortisol was assessed for three days each pre- and post-treatment, at 8am, 12pm, 4pm, and 8pm. Mixed model analyses assessed whether GAD symptom change predicted the degree to which cortisol levels changed during treatment.ResultsSymptom improvement during treatment was significantly associated with pre-to-post treatment changes in cortisol. Subjects who experienced more symptomatic improvement experienced significant increases in their morning salivary cortisol (β= 0.48,p< 0.001), and a greater decrease in cortisol from morning to the rest of the day (β= 0.55,p< 0.001). In addition, at baseline a lower cortisol level (β= −0.24,p= 0.023) and a lesser decrease in cortisol after morning (β= 0.30,p= 0.003) were associated with greater symptomatic improvement.ConclusionIncreases in morning salivary cortisol and the diurnal cortisol slope are associated with symptom improvement in chamomile treatment of GAD. Response to treatment for GAD could partially stem from normalization of stress biology dysfunction, but further work involving establishing abnormalities within-sample, ruling out of confounds (e.g., sleep), and a placebo control is necessary to conclude an amelioration effect.Registration codeNCT01072344.URLhttps://clinicaltrials.gov/ct2/show/NCT01072344.