An exploratory study of salivary cortisol changes during chamomile extract therapy of moderate to severe generalized anxiety disorder Journal Article


Authors: Keefe, J. R.; Guo, W.; Li, Q. S.; Amsterdam, J. D.; Mao, J. J.
Article Title: An exploratory study of salivary cortisol changes during chamomile extract therapy of moderate to severe generalized anxiety disorder
Abstract: Objectives Dysfunctions 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). Methods Among 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. Results Symptom 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. Conclusion Increases 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 code NCT01072344. URL https://clinicaltrials.gov/ct2/show/NCT01072344. © 2017
Keywords: adult; controlled study; treatment response; middle aged; major clinical study; clinical trial; placebo; treatment duration; disease association; generalized anxiety disorder; stress; open study; hydrocortisone; primary medical care; psychopharmacology; beck depression inventory; cortisol; chamomile; dsm-iv; human; male; female; priority journal; article; structured clinical interview for dsm disorders; gad; chemiluminescence immunoassay; clinical global impression scale; drug saliva level
Journal Title: Journal of Psychiatric Research
Volume: 96
ISSN: 0022-3956
Publisher: Pergamon Elsevier Science Ltd  
Date Published: 2018-01-01
Start Page: 189
End Page: 195
Language: English
DOI: 10.1016/j.jpsychires.2017.10.011
PROVIDER: scopus
PMCID: PMC5710842
PUBMED: 29080520
DOI/URL:
Notes: Article -- Export Date: 4 December 2017 -- Source: Scopus
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MSK Authors
  1. Jun J Mao
    46 Mao
  2. Qing Susan Li
    9 Li