The hormone cortisol, produced in the adrenal glands, is important for many bodily functions. It helps regulate blood pressure, inflammation, blood sugar levels, and the appropriate use of nutrients. However, cortisol is probably best known as a “stress hormone” that helps regulate mood, fear, and fight-or-flight response.
Like many other necessary hormones, cortisol can create serious problems in the wrong amounts. We’ve previously talked on this blog about how cortisol relates to a good night’s sleep. Healthy levels of cortisol help us feel alert in the morning, but excessive levels can lead to insomnia.
There are other ways that cortisol may affect behavioral health. Let’s take a look at some connections that behavioral health providers may want to keep in mind.
There is a link between high cortisol and serious mental illness.
Over the past decade, researchers have found that individuals who are considered clinically high-risk for psychosis tend to have higher cortisol levels than healthy individuals. In fact, another study found that high levels of stress hormones can be toxic to the brain. This may help explain why cortisol is linked to mental health issues, including depression and anxiety.
However, high cortisol levels may be associated with mental illness, without being the cause. It’s also not always obvious whether high cortisol levels or mental illness symptoms appear first. For example, people who experienced adverse childhood events (ACEs), such as physical abuse or homelessness, tend to have higher levels of cortisol, as well as risk of mental health concerns. Like other areas of behavioral health, the role of cortisol is complicated and calls for further research.
Cortisol may influence treatment effectiveness.
Research published in August 2022 in the journal Alcoholism: Clinical and Experimental Research found that cortisol levels could help predict which individuals were most likely to stay in a program for substance use disorder (SUD). The study participants were all males, and the program was an abstinence-based, residential SUD recovery program.
The participants who left before 90 days had significantly higher initial cortisol levels than those who stayed for 90 days or longer. This may be linked to the participants’ experience of ACEs, which may itself affect the likelihood of remaining in a recovery program.
High cortisol can have physical causes.
Although chronic stress can lead to abnormally high levels of cortisol, there are also medical causes with mental health symptoms. This may be diagnosed as Cushing’s disease, or Cushing’s syndrome, which involves chronically high levels of cortisol.
Physical causes of high cortisol include:
- Tumors on the pituitary or adrenal glands
- Kidney disease
- Underactive thyroid (hypothyroidism)
- Overuse of corticosteroids
The mental health symptoms that can accompany Cushing’s syndrome may include depression, anxiety, irritability, lack of emotional control, and cognitive impairment. Behavioral health providers whose clients have excessive levels of cortisol may want to consider the possibility of physical causes.
If there is no physical cause of high cortisol, behavioral health clinicians might recommend lifestyle changes that may help reduce stress. These include regular exercise, meditation, breathing exercises, engaging in healthy hobbies, and positive social connections and interactions.
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