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Neurohormones, Neurodevelopment, and Psychosis 275Average cortisol (mg/dl)0.80.70.60.50.40.30.2* *Off On Off On Off OnStimulant Antidepressant AntipsychoticFigure 12-1 Mean (SD) cortisol levels by current medication status.of medication, there was a significant increment in R2 for Block II. Again, thesame pattern of findings held when children who did not meet clinical criteria wereexcluded. Because there is evidence that citalopram may be associated with anincrease in cortisol, whereas other antidepressants decrease cortisol, data were alsoanalyzed excluding subjects on citalopram. There was no significant relation betweenantidepressant use and cortisol, although the trend was toward lower cortisolin those on antidepressants. The same pattern held when data from the clinicalsubgroup (i.e., those with Axis II diagnosis) were analyzed separately.In order to examine the effects of past medication, the same analytic proceduredescribed above was employed. For these analyses there was no significant relationbetween past use of any of the three drug classes and cortisol.In summary, controlling for age and other medications, current stimulant medicationwas associated with significantly higher mean cortisol. Antipsychotic medicationwas associated with significantly lower cortisol. There was no relationbetween antidepressant medication and cortisol level, although there was a trendtoward lower cortisol in youth on antidepressants. This pattern mirrors the trendsobserved in studies of adult patients.This is not a controlled experimental study, so we cannot conclude that the relationbetween cortisol and medication reflects a causal effect of the psychotropics.Instead, the differences may reflect characteristics of the adolescents thatpredated their medication. Nonetheless, there are several reasons for tentativelyconcluding that the relation reflects a medication effect. First, we find only a relationbetween the cortisol secretion and current medication; past psychotropicexposure is not linked with cortisol. Second, the pattern of findings is generallyconsistent with controlled studies on adults. Finally, the pattern of findings isconsistent with what would be expected from the mechanisms of action of thedrugs. Thus it is most plausible that the relations between cortisol and currentmedication observed in this study reflect the effects of the drugs on glucocorticoidsecretion.