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Elevated Cortisol Levels in Children with Anxiety Disorders

These biologic test results provide strong evidence of the continuity of anxiety disorders across the age span.

Researchers have reported that children and adults with anxiety disorders share similar respiratory responses to the CO₂ inhalation challenge test (Journal Watch Psychiatry Jan 23 2001). Cortisol levels before CO₂ inhalation in adults with anxiety disorders have been reported to be higher than those in healthy adults, and so these investigators tested salivary cortisol levels before CO₂ inhalation in 62 children with anxiety disorders (panic disorder, social phobia, separation anxiety, or generalized anxiety disorder) or depression (17 children with comorbid depression, 5 with "pure" depression) and in 36 age-matched, healthy children. Participants underwent cortisol testing at baseline and before and after CO₂ inhalation on the same day.

Children with anxiety disorders who developed panic symptoms during CO₂ inhalation had significantly higher mean levels of cortisol before CO₂ inhalation than did anxiety-disordered children who did not develop panic and normal children; cortisol levels in the group of nonpanicking, anxiety-disordered children did not differ significantly from those of the normal group. Similarly, among anxiety-disordered children without depression, cortisol levels before CO₂ inhalation were significantly higher in the 14 children who developed panic symptoms during inhalation than levels in the patients who did not panic.

Comment: As the authors note, these biologic test results provide strong evidence of the continuity of anxiety disorders across the age span. These findings, which were based on relatively small subgroups, warrant further research into the role of comorbid depression in anxiety disorders. The findings are consistent with the reported role of the hypothalamic-pituitary-adrenal axis in anxiety and depression.

— Barbara Geller, MD

Published in Journal Watch Psychiatry April 25, 2002

Citation(s):

Coplan JD et al. Salivary cortisol concentrations before and after carbon-dioxide inhalations in children. Biol Psychiatry 2002 Feb 15; 51:326-33.

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