Cortisol and Anxiety

Somebody asked me about the relationship between hormones and anxiety so I did some research and found some really interesting information about cortisol and anxiety. Rather than focus on a particular study I’m going to just go through some of the more interesting connections.

Cortisol is a long-term (more than 3 minutes) stress hormone that can affect most cells. It will increase blood sugar levels, alter the immune system, suppress the digestive system, and suppress reproductive systems. These actions should help you deal with a stressor but they should also disappear when the stressor is gone.

Most research on cortisol tends to focus on the negative side of things. For example, Aguilar, Jiménez, and Alvero-Cruz (2013) found that elite field hockey players had higher cortisol levels and higher anxiety before important games. In a broader study, Vreeburg et al (2010) found that individuals with current anxiety disorders, particularly panic disorder with agoraphobia (fear and avoidance of places and situations that might cause an individual to panic) and those with both anxiety and depression.

Mantella et al’s (2008) findings of higher cortisol levels in seniors with generalized anxiety disorder also indicate a significant relationship between high cortisol levels and anxiety. On the other end of the age spectrum, O’Connor et al (2005) found that prenatal anxiety (ie maternal anxiety during pregnancy) was positively related to cortisol levels once the children reached 10 years of age. From what I could find, this is still a correlation in that the the two are connected but causality is not clear (ie, it is unclear if higher cortisol causes anxiety, if anxiety causes higher cortisol, or if there is another mediating factor.

Lai et al (2005) took an alternative look and found that optimism and cortisol levels were negatively correlated with more optimistic individuals secreting less cortisol when waking. This was particularly evident in male subjects who also had lower cortisol levels overall during this period compared to women.

It makes sense that cortisol which is released in response to stress would be connected to anxiety. We tend to feel anxious when we are going into or experiencing stressful situations but our current society doesn’t always create stress in ways that the effects of cortisol are actually beneficial. Higher blood sugar levels, for example, will help if you need to engage in strenuous physical activity in order to stay alive, but it has less benefit if it is triggered by a trip to a grocery store during a global pandemic or a high stakes exam in your biology class.

Estrogen and testosterone have also been linked to anxiety; however, the connection seems even less clear. For example, Borrow and Handa (2017) report various studies have found that significant changes in estrogen levels pre-puberty, during menopause, and during monthly menstruation cycles are associated with higher anxiety levels. Their specific research though, appears to indicate the same system that cortisol is found in, possibly indicating a connection between the two.

Testosterone is often connected with risk taking behaviours and van Honk, Peper, and Schutter (2005) found that testosterone did reduce fear responses but did not impact consciously experienced anxiety. Many studies investigate potential relationships between testosterone and cortisol but as these deal more with issues such as social aggression I will leave them for a future post.

We are currently living in stressful times (can anyone say global pandemic, political unrest, and systemic racism?). Anxiety is a real and valid issue that we need to talk about openly in our society in order to reduce stigma and ensure that people are able to access appropriate support that fits who they are and the causes and triggers of their anxiety. Continuing to research these complex issues is important to individual health but also the progress of our society.

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