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Mental Stress Follows Mental Rules

Center for Psychobiological and Psychosomatic Research University of Trier Trier D-54286, Germany

In a recent study, Komesaroff et al. (1) reported the effects of an 8-week estrogen treatment on endocrine responses to mental stress in perimenopausal women. Among other effects, they reported reduced ACTH and cortisol responses after estrogen treatment. Although the data seem to support findings of reduced hypothalamus-pituitary-adrenal (HPA) stress responses to mental stress in premenopausal women compared to men (2), the present results are difficult to interpret.

We know that the HPA response to mental stress is profoundly influenced by novelty, predictability, controllability, and anticipation of the stressful situation (3). As we (4, 5) and other laboratories (6) have shown, HPA responses significantly decrease when subjects are exposed to the same stress or repeatedly. The response decrement reflects psychological processes including coping, appraisal of the situation and others. The reported effects of lower HPA responses to the second stress test in the estrogen-treated subjects are, therefore, significantly confounded with habituation to the repeated stress tests. Furthermore, habituation to repeated psychological stress seems to be a function of personality traits like low self-esteem and neuroticism (4). Unfortunately, no information on subjective responses or personality traits have been provided.

A second problem with the study protocol is the timing of blood samples. Thirty minutes after brachial cannulation, a "baseline" blood sample was obtained by Komesaroff et al. (1) However, this measure can hardly serve as a baseline because there is ample evidence for significant endocrine responses to catheterization with large individual differences (e.g. Refs. 7, 8). With only five or seven subjects in each group (as in the present study), it takes only one or two subjects responding to the stress of catheterization to obtain elevated baseline levels 30 min later. This is most evident in the norepinephrine, epinephrine, and ACTH levels in the estrogen group before treatment. ’Basal’ levels differed as much as 200% and more between the two groups on the first stress test, which in turn can have a profound effect on the endocrine responsiveness, and a comparison of the endocrine responses to the two stress exposures. It, therefore, remains an open question whether or not estradiol treatment will alter the endocrine stress response in postmenopausal women. In light of the wide-spread use of estrogen replacement therapy, this is an important research area that requires more detailed investigations. It is to be hoped that in future studies the psychology behind endocrine responses will be carefully considered when mental stress is investigated.

References

1. Komesaroff PA, Esler MD, Sudhir K. 1999 Estrogen supplementation attenuates glucocorticoid and catecholamine responses to mental stress in perimenopausal women. J Clin Endocrinol Metab. 84:606–610.[Abstract/Free Full Text]
2. Kirschbaum C, Kudielka BM, Gaab J, et al. 1999 Impact of gender, menstrual cycle phase, and oral contraceptives on the activity of the hypothalamus-pituitary-adrenal axis. Psychosom Med. 61:154–162.[Abstract/Free Full Text]
3. Mason JW. 1968 A review of psychoendocrine research on the pituitary-adrenal cortical system. Psychosom Med. 30:576–607.[Abstract/Free Full Text]
4. Kirschbaum C, Prüssner J, Gaab J, et al. 1995 Persistent high cortisol responses to repeated psychological stress in a subpopulation of healthy men. Psychosom Med. 57:468–474.[Abstract/Free Full Text]
5. Deinzer R, Kirschbaum C, Gresele C, et al. 1997 Adrenocortical responses to repeated parachute jumping and subsequent h-CRH challenge in inexperienced healthy subjects. Physiol. Behav. 61:507–511.
6. Natelson BH, Ottenweiler JE, Cook JA, et al. 1988 Effect of stressor intensity on habituation of the adrenocortical stress response. Physiol Behav 43:41–46.
7. Brown WA, Heninger G. 1975 Cortisol, growth hormone, free fatty acids, and experimentally evoked affective arousal. Am J Psychiatry. 132:1172–1176.[Abstract/Free Full Text]
8. Hubert W, Möller M, Nieschlag E. 1989 Stress reactions in response to the procedure of LHRH tests as measured by salivary and serum cortisol and psychological variables. Horm Res32 :198–202.

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