Abstract
Introduction: Allostatic load (AL) index proposes indicators for the functioning of the main potentially stress-affected systems. Sex differences in stress response and stress-related diseases susceptibility have been described for the general population. In this observational study we describe the effects of sex and age on AL variables, in a cohort of patients with general anxiety disorders and neuroticism treated with alprazolam during 12 weeks, before and after treatment. Methods: Patients with general (DSM IV) anxiety disorders with >6 in Hamilton scale, AL (>1 Crimmins and Seeman AL modified criteria) and neuroticism >18 (NEO-FFI inventory), were included. All patients completed psychiatric assessment, AL index determination before (−1 week) and after 12 weeks of treatment with alprazolam (0.25 - 1 mg/t.i.d). Allostatic load parameters comprised cardiovascular, metabolic and inflammatory variables. Univariate analysis (two-way ANOVA), Student’s t-test (related variables) and Pearson correlations were determined. Results: Fifty-four patients, 35 females (48.6 ± 11.7 years) and 19 males (44.2 ± 12.8 years) with general anxiety disorder were included; 28 patients with <50 years (60.7% females), and 26 with ≥50 years (69.2% females). Younger patients (<50 years) (two-way ANOVA, p = 0.02) were significantly associated with lower AL index after treatment. However, women showed higher anxiety levels in both, before (two-way ANOVA, p = 0.059) and after treatment (two-way ANOVA, p = 0.005), with a significantly better profile than men in many individual AL variables, particularly cardiovascular (systolic blood pressure), obesity (body mass index), and lipids (higher HDL levels). After treatment a higher reduction of fibrinogen levels was found in men (two-way ANOVA, p = 0.02). Conclusions: In this preliminary analysis we described sex and age differences in psychiatry aspects and AL indexes in patients with general anxiety disorders in the short-term treatment with alprazolam. These considerations remark the need of pondering sex and age differences during the use of drugs for protracted periods.
Highlights
IntroductionTo ensure a favorable assessment of the cumulative influence of stress on health, Seeman and Crimmins first developed Allostatic Load (AL) index in 1997 and proposed indicators for the functioning of the main potentially stress-affected systems [1] [2]
Allostatic load (AL) index proposes indicators for the functioning of the main potentially stress-affected systems
In this observational study we describe the effects of sex and age on AL variables, in a cohort of patients with general anxiety disorders and neuroticism treated with alprazolam during 12 weeks, before and after treatment
Summary
To ensure a favorable assessment of the cumulative influence of stress on health, Seeman and Crimmins first developed Allostatic Load (AL) index in 1997 and proposed indicators for the functioning of the main potentially stress-affected systems [1] [2]. Women showed higher levels of inflammatory markers, but with lower rates of increase in inflammation mediators with age [20] Despite the existence of theoretical explanations for sexual dimorphism and age effects in stress response; the empirical evidence is scarce, among special populations with psychiatric disorder [19] [21] [26] In this observational study we prospectively analyzed the clinical psychiatric profile and the AL index in a cohort of patients with GAD treated with alprazolam (a positive allosteric modulator of GABA A receptor) during 12 weeks, and determined the effects of sex and age on allostatic load variables before and after treatment
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