Skip to main content

The efficacy of initial hydrocortisone administration at preventing posttraumatic distress in adult trauma patients: a randomized trial

  • Douglas L. Delahanty (a1) (a2), Crystal Gabert-Quillen (a1), Sarah A. Ostrowski (a3), Nicole R. Nugent (a4), Beth Fischer (a5), Adam Morris (a1), Roger K. Pitman (a6), John Bon (a7) and William Fallon (a2)...

Secondary pharmacological interventions have shown promise at reducing the development of posttraumatic stress disorder symptoms (PTSS) in preclinical studies. The present study examined the preliminary efficacy of a 10-day low-dose (20 mg bid) course of hydrocortisone at preventing PTSS in traumatic injury victims.


Sixty-four traumatic injury patients (34% female) were randomly assigned in a double-blind protocol to receive either a 10-day course of hydrocortisone or placebo initiated within 12 hours of the trauma. One-month and 3-months posttrauma participants completed an interview to assess PTSS and self-report measures of depression and health-related quality of life.


Hydrocortisone recipients reported fewer PTSD and depression symptoms, and had greater improvements in health-related quality of life during the first 3 months posttrauma than did placebo recipients. Hydrocortisone recipients who had never received prior mental health treatment had the lowest PTSD scores.


Low-dose hydrocortisone may be a promising approach to the prevention of PTSD in acutely injured trauma patients, and may be particularly efficacious in acutely injured trauma victims without a history of significant psychopathology.

Corresponding author
*Address for correspondence: Douglas Delahanty, Department of Psychology, 144 Kent Hall, Kent, OH 44242, USA. (Email
Hide All

Funding for this study was provided by the National Institute of Mental Health (R34 MH73014) and the Ohio Board of Regents.

Hide All
1.Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005; 62(6): 617627.
2.Pietrzak RH, Goldstein RB, Southwick SM, Grant BF. Prevalence and Axis I comorbidity of full and partial posttraumatic stress disorder in the United States: results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. J Anxiety Disord. 2011; 25(3): 456465.
3.Friedman MJ, Yehuda R. Post-traumatic stress disorder and comorbidity: psychobiological approaches to differential diagnosis. In: Friedman MJ, Charney DS, Deutch AY, eds. Neurobiological and Clinical Consequences of Stress: From Normal Adaptation to Post-Traumatic Stress Disorder. Philadelphia: Lippincott Williams & Wilkins Publishers; 1995: 429445.
4.Deering CG, Glover SG, Ready D, Eddleman HC, Alarcon RD. Unique patterns of comorbidity in posttraumatic stress disorder from different sources of trauma. Compr Psychiatry. 1996; 37(5): 336346.
5.Tucker P, Pfefferbaum B, Doughty DE, etal. Body handlers after terrorism in Oklahoma City: predictors of posttraumatic stress and other symptoms. Am J Orthopsychiatry. 2002; 72(4): 469475.
6.Oquendo MA, Friend JM, Halberstam B, etal. Association of comorbid posttraumatic stress disorder and major depression with greater risk for suicidal behavior. Am J Psychiatry. 2003; 160: 580582.
7.Kobayashi I, Boarts JM, Delahanty DL. Polysomnographically measured sleep abnormalities in PTSD: a meta-analytic review. Psychophysiology. 2007; 44(4): 660669.
8.Caldwell BA, Redeker N. Sleep and trauma: an overview. Issues Ment Health Nurs. 2005; 26(7): 721738.
9.Boscarino JA. Posttraumatic stress disorder and physical illness: results from clinical and epidemiologic studies. In: Yehuda R, McEwen B, eds. Biobehavioral Stress Response: Protective and Damaging Effects. New York: New York Academy of Sciences; 2004: 141153.
10.Mayou R, Ehlers A, Hobbs M. Psychological debriefing for road traffic accident victims: three-year follow-up of a randomised controlled trial. Br J Psychiatry. 2000; 176: 589593.
11.Rose S, Brewin CR, Andrews B, etal. A randomized controlled trial of individual psychological debriefing for victims of violent crime. Psychol Med. 1999; 29: 793799.
12.Larkin M. Can post-traumatic stress disorder be put on hold? Lancet. 1999; 354: 1008.
13.Pitman RK. Post-traumatic stress disorder, hormones, and memory. Biol Psychiatry. 1989; 26: 221223. Quervain DJ, Henke K, Aerni A, etal. Glucocorticoid-induced impairment of declarative memory retrieval is associated with reduced blood flow in the medial temporal lobe. Eur J Neurosci. 2003; 17(6): 12961302.
15.Kirschbaum C, Wolf OT, May M, Wippich W, Hellhammer DH. Stress- and treatment-induced elevations of cortisol levels associated with impaired declarative memory in healthy adults. Life Sci. 1996; 58: 14751483.
16.Mauri M, Sinforiani E, Bono G, etal. Memory impairment in Cushing's disease. Acta Neurol Scand. 1993; 87: 5255.
17.Newcomer JW, Craft S, Hershey T, Askins K, Bardgett ME. Glucocorticoid-induced impairment in declarative memory performance in adult humans. J. Neurosci. 1994; 14: 20472053.
18.Newcomer JW, Selke G, Melson AK, etal. Decreased memory performance in healthy humans induced by stress-level cortisol treatment. Arch Gen Psychiatry. 1999; 56: 527533.
19.Wolkowitz OM, Reus VI, Weingartner H, etal. Cognitive effects of corticosteroids. Am J Psychiatry. 1990; 147: 12971303.
20.Lupien SJ, McEwen BS. The acute effects of corticosteroids on cognition: integration of animal and human model studies. Brain Res Rev. 1997; 24: 127.
21.Martignoni E, Costa A, Sinforiani E, etal. The brain as a target for adrenocortical steroids: cognitive implications. Psychoneuroendocrinology. 1992; 171: 343354.
22.deQuervain DJ, Aerni A, Schelling G, Roozendaal B. Glucocorticoids and the regulation of memory in health and disease. Front Neuroendocrinol. 2009; 30: 358370.
23.Schelling G, Stoll C, Kapfhammer HP, etal. The effect of stress doses of hydrocortisone during septic shock on posttraumatic stress disorder and health-related quality of life in survivors. Crit Care Med. 1999; 27: 26782683.
24.Schelling G, Briegel J, Roozendaal B, etal. The effect of stress doses of hydrocortisone during septic shock on posttraumatic stress disorder in survivors. Biol Psychiatry. 2001; 50: 978985.
25.Schelling G, Kilger E, Roozendaal B, etal. Stress doses of hydrocortisone, traumatic memories and post-traumatic stress disorder in patients after cardiac surgery: a randomized study. Biol. Psychiatry.. 2004; 55: 627633.
26.Zohar J, Yahalom H, Kozlovsky N, etal. High dose hydrocortisone immediately after trauma may alter the trajectory of PTSD: interplay between clinical and animal studies. Eur Neuropsychopharmacol. 2011; 21(11): 796809.
27.Breslau N, Davis GC, Peterson EL, Schultz LR. A second look at comorbidity in victims of trauma: the posttraumatic stress disorder–major depression connection. Biol Psychiatry. 2000; 48: 902909.
28.Campbell DG, Felker BL, Liu C, etal. Prevalence of depression–PTSD comorbidity: implications for clinical practice guidelines and primary care-based interventions. J Gen Intern Med. 2007; 22(6): 711718.
29.Clark DB, Kirisci L. PTSD, depression, and adolescent alcohol use disorders and quality of life in adolescents. Anxiety. 1996; 2: 226233.
30.Eisenman DP, Gelberg L, Liu H, Shapiro MF. Mental health and health-related quality of life among adult Latino primary care patients living in the United States with previous exposure to political violence. JAMA. 2003; 290: 627634.
31.Warshaw MG, Fierman E, Pratt L, etal. Quality of life and dissociation in anxiety disorder patients with histories of trauma or PTSD. Am J Psychiatry. 1993; 150(10): 15121516.
32.Zatzick DF, Marmur CR, Weiss DS, etal. Posttraumatic stress disorder and functioning and quality of life outcomes in a nationally representative sample of male Vietnam veterans. Am J Psychiatry. 1997; 154: 16901695.
33.Blanchard EB, Hickling EJ, Taylor AE, etal. Who develops PTSD from motor vehicle accidents? Behav Res Ther. 1996; 34(1): 110.
34.Blanchard EB, Hickling EJ, Taylor AE, Loos W, Gerardi RJ. Psychological morbidity associated with motor vehicle accidents. Behav Res Ther. 1994; 3: 283290.
35.Breslau N, Davis GC. Posttraumatic stress disorder in an urban population of young adults: risk factors for chronicity. Am J Psychiatry. 1992; 149(5): 671675.
36.McFarlane AC. The etiology of post-traumatic morbidity: predisposing, precipitating and perpetuating factors. Br J Psychol. 1989; 154: 221228.
37.Shalev AY, Freedman A, Peri T, etal. Prospective study of posttraumatic stress disorder and depression following trauma. Am J Psychiatry. 1998; 155(5): 630637.
38.Ullman SE, Siegel JM. Predictors of exposure to traumatic events and posttraumatic stress sequelae. J Community Psychol. 1994; 22: 328338.
39.Ursano RJ, Fullerton CS, Epstein RS, etal. Acute and chronic posttraumatic stress disorder in motor vehicle accident victims. Am J Psychiatry. 1999; 156: 589595.
40.Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet. 1974; 2: 8184.
41.Ozer EJ, Best SR, Lipsey TL, Weiss DS. Predictors of posttraumatic stress disorder and symptoms in adults. Psychol Bull. 2003; 129(1): 5273.
42.Marmar CR, Weiss DS, Metzler TJ. The Peritraumatic Dissociative Experiences Questionnaire. In: Wilson JP, Keane TM, eds. Assessing Psychological Trauma PTSD, 1st ed.New York: Guilford; 1997: 412428.
43.Birmes P, Brunet A, Carreras D, etal. The predictive power of peritraumatic dissociation and acute stress symptoms for posttraumatic stress symptoms: a three month prospective study. Am J Psychiatry. 2003; 160: 13371339.
44.Birmes P, Carreras D, Charlet J-P, etal. Peritraumatic dissociation and posttraumatic stress disorder in victims of violent assault. J Nerv Ment Dis. 2001; 189: 796798.
45.Pitman RK, Sanders KM, Zusman RM, etal. Pilot study of secondary prevention for posttraumatic stress disorder with propranolol. Biol Psychiatry. 2002; 51: 189192. Quervain DJ, Roozendaal B, Nitsch RM, McGaugh JL, Hock C. Acute cortisone administration impairs retrieval of long-term declarative memory in humans. Nat Neurosci. 2000; 3(4): 313314.
47.Kirschbaum C, Wolf OT, May M, Wippich W, Hellhammer DH. Stress- and treatment-induced elevations of cortisol levels associated with impaired declarative memory in healthy adults. Life Sci. 1996; 58: 14751483.
48.DiPasquale G, Steinetz BG. Relationship of food intake to the effect of cortisone acetate on skin wound healing. Proc Soc Exp Biol Med. 1964; 117: 118120.
49.Fauci AS, Dale DC, Balow JE. Glucocorticosteroid therapy: mechanisms of action and clinical considerations. Ann Intern Med. 1976; 84(3): 304315.
50.Anstead GM. Steroids, retinoids, and wound healing. Adv Wound Care. 1998; 11: 277285.
51.Blake DD, Weathers FW, Nagy LM, etal. The development of a clinician-administered PTSD scale. J Trauma Stress. 1995; 8(1): 7590.
52.Radloff LS. The CES-D scale: a new self-report depression scale for research in the general population. Appl Psychol Meas. 1977; 1: 385401.
53.Ware JE, Sherbourne CD. The MOS 36-Item Short-Form Health Survey (SF-36): conceptual framework and item selection. Med Care. 1992; 30(6): 473483.
54.Brunet A, Weiss DS, Metzler TJ, etal. The Peritraumatic Distress Inventory: a proposed measure of PTSD criterion A2. Am J Psychiatry. 2001; 158: 14801485.
55.Schnurr PP, Friedman MJ, Foy DW, etal. Randomized trial of trauma-focused group therapy for posttraumatic stress disorder: results from a Department of Veterans’ Affairs cooperative study. Arch Gen Psychiatry. 2003; 60: 481489.
56.Winston FA, Kassam-Adams N, Garcia-Espana F, Ittenbach R, Cnaan A. Screening for risk of persistent posttraumatic stress in injured children and their parents. JAMA. 2003; 290: 643649.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

CNS Spectrums
  • ISSN: 1092-8529
  • EISSN: 2165-6509
  • URL: /core/journals/cns-spectrums
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Altmetric attention score

Full text views

Total number of HTML views: 5
Total number of PDF views: 118 *
Loading metrics...

Abstract views

Total abstract views: 480 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 20th November 2017. This data will be updated every 24 hours.