The cortisol axis and psychiatric disorders: an updated review

Abstract

Cortisol, a key hormone in the body’s stress response, plays a complex role in the development and progression of various psychiatric illnesses. Elevated or dysregulated cortisol levels are linked to mood disorders, including anxiety and depression, where both high and low cortisol can impair cognitive function and emotional stability. In children, chronic stress and high cortisol exposure can lead to long-term behavioral problems, affecting memory, decision-making, and emotional regulation, especially when early-life adversity is present. Similarly, in adults, prolonged cortisol dysregulation often contributes to cognitive decline, mood instability, and an increased vulnerability to psychiatric conditions like major depressive disorder and bipolar disorder. Structural changes in stress-sensitive brain regions, such as the hippocampus and amygdala, are common, as chronic cortisol exposure can cause atrophy in these areas, affecting memory, fear responses, and executive function. This relationship underscores the critical role of managing stress and cortisol levels to prevent or alleviate psychiatric symptoms across the lifespan. In this review, the authors highlight the latest findings regarding the cortisol-psychiatric illness relationship and the available treatment options involving this target.