Cortisol and Catecholamines in Posttraumatic Stress Disorder

BACKGROUND: Prior research has connected posttraumatic stress disorder (PTSD) to increased levels of catecholamines. However, studies of cortisol levels have produced mixed results. OBJECTIVE: To examine urinary catecholamine and cortisol levels in individuals with PTSD in a community sample. DESIGN: A representative cohort of young adult community residents, assessed periodically during a 10-year period for exposure to trauma and PTSD, was used to select a subset for urine collection studies conducted in a sleep laboratory across 2 consecutive nights and the intermediate day. SETTING: The sample of young adults was randomly selected from a large health maintenance organization and is representative of the geographic area except for the extremes of the socioeconomic status range. PARTICIPANTS: A subsample was selected from the 10-year follow-up cohort (n = 913; 91.1% of the initial sample). Eligibility criteria were: (1) persons exposed to trauma during the preceding 5 years, (2) other individuals who met PTSD criteria, and (3) a random preselected subsample. Of 439 eligible individuals, 292 (66.5%) participated, including 69 with lifetime PTSD. MAIN OUTCOME MEASURES: Measures of cortisol and catecholamine levels in urine. RESULTS: The lifetime PTSD group demonstrated significantly higher catecholamine levels than the group exposed to trauma without PTSD and the nonexposed group. Individuals exposed to trauma without PTSD demonstrated significantly lower urine catecholamine levels than the nonexposed and the PTSD groups. Mean cortisol levels did not differ across groups. When analyzed by comorbidity with major depressive disorder (MDD), the PTSD-only group did not differ in cortisol levels from the groups with neither PTSD nor MDD. Women with MDD plus PTSD demonstrated significantly higher cortisol levels than women with neither disorder or with either disorder alone. CONCLUSIONS: Trauma per se does not lead to sustained increases in cortisol or catecholamine levels. Posttraumatic stress disorder is associated with higher catecholamine levels. In contrast, persons with PTSD had neither an increase nor a decrease in mean urinary cortisol levels. Women with PTSD and comorbid MDD had higher cortisol levels.