Hydrocortisone in the emergency department: A prospective, double-blind, randomized, controlled PTSD study. Hydrocortisone during golden hours

Lior Carmi, Joseph Zohar, Tal Weissman, Alzbeta Juven-Wetzler, Linda Bierer, Rachel Yehuda, Hagit Cohen

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: A blunted response of the hypothalamic-pituitary-adrenal (HPA) axis immediately after exposure to traumatic events has been proposed as a risk factor for posttraumatic stress disorder (PTSD). Accordingly, administration of hydrocortisone in the aftermath of a traumatic event is indicated. This study consisted of a randomized, placebo-controlled, double-blind trial investigating whether a single intravenous dose of hydrocortisone administered within 6 hours after exposure to trauma would reduce the incidence of PTSD at the 13-month follow-up. Methods: A total of 118 consented patients with acute stress symptoms, were administered a single intravenous bolus of hydrocortisone/placebo within 6 h of the traumatic event. Blood samples were taken before Hydrocortisone administration. Results: At 13-months, the hydrocortisone group did not differ from the placebo group regarding PTSD prevalence or symptom severity. However, a significant interaction between time of the trauma (i.e., night, when cortisol's level is low) and treatment was found. Specifically, a lower prevalence of PTSD was found at the 13-month follow-up in the hydrocortisone night group. Conclusions: Administration of hydrocortisone within six hours of the traumatic event, was not effective in preventing PTSD compared to Placebo. However, nocturnal administration (when cortisol levels are low) may suggest a new venue for research.

Original languageEnglish
JournalCNS Spectrums
DOIs
StateAccepted/In press - 2022
Externally publishedYes

Keywords

  • Cortisol
  • Golden Hours
  • HPA axis
  • Hydrocortisone
  • PTSD

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