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Hydrocortisone in the emergency department: a prospective, double-blind, randomized, controlled posttraumatic stress disorder study. Hydrocortisone during golden hours

Published online by Cambridge University Press:  09 June 2022

Lior Carmi Open the ORCID record for Lior Carmi [Opens in a new window] ,
Joseph Zohar ,
Tal Weissman ,
Alzbeta Juven-Wetzler ,
Linda Bierer ,
Rachel Yehuda  and
Hagit Cohen
Lior Carmi
Affiliation:
Post Trauma Center, Chaim Sheba Medical Center, Ramat Gan, Israel The Data Science Institution, The Inter Disciplinary Center, Herzliya, Israel
Joseph Zohar*
Affiliation:
Post Trauma Center, Chaim Sheba Medical Center, Ramat Gan, Israel
Tal Weissman
Affiliation:
Post Trauma Center, Chaim Sheba Medical Center, Ramat Gan, Israel
Alzbeta Juven-Wetzler
Affiliation:
The Psychiatry Department, Chaim Sheba Medical Center, Tel Hashomer, Israel
Linda Bierer
Affiliation:
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
Rachel Yehuda
Affiliation:
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA PTSD Clinical Research Program & Laboratory of Clinical Neuroendocrinology and Neurochemistry, James J. Peters Veterans Affairs Medical Center, New York, NY, USA
Hagit Cohen
Affiliation:
Anxiety and Stress Research Unit, Ben-Gurion University of the Negev, Beer Sheva, Israel
*
*Author for correspondence: Joseph Zohar, Email: Joseph.Zohar@sheba.health.gov.il
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Abstract

Objectives

A blunted response of the hypothalamic-pituitary-adrenal 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 hours 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 (ie, 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 6 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.

Keywords

Posttraumatic stress disorderhydrocortisonegolden hourshypothalamic-pituitary-adrenal axiscortisol
Type
Original Research
Information
CNS Spectrums , Volume 28 , Issue 4 , August 2023 , pp. 457 - 463
Copyright
© The Author(s), 2022. Published by Cambridge University Press

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