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Morning plasma cortisol and diurnal profiles of salivary cortisol and salivary alpha amylase (sAA) activity were assessed, also reactivity of HPA\u2010axis, sAA activity, and heart rate following a psychosocial stressor (Trier Social Stress Test for children). GAD patients with comorbid depression showed increased morning plasma and salivary cortisol levels, ameliorating throughout in\u2010patient treatment, and higher sAA activity in their diurnal profile. Both HPA and sympathetic activity positively correlated with the severity of anxiety and depression. We also demonstrated a blunted HPA and sympathetic response to acute stress in patients. This pattern of neuroendocrine and sympathetic changes seems to be distinct from the one previously reported in pediatric patients with only social anxiety or depressive disorders. We propose morning plasma and saliva cortisol levels as potential physiological indicators for supporting the evaluation of symptoms' severity and treatment progress in children with GAD and comorbid depressive disorder.<\/jats:p>","DOI":"10.1002\/smi.2736","type":"journal-article","created":{"date-parts":[[2016,12,17]],"date-time":"2016-12-17T15:27:00Z","timestamp":1481988420000},"page":"518-529","source":"Crossref","is-referenced-by-count":26,"title":["Stress system dysregulation in pediatric generalized anxiety disorder associated with comorbid depression"],"prefix":"10.1002","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2741-9445","authenticated-orcid":false,"given":"R.","family":"Funke","sequence":"first","affiliation":[{"name":"Department of Child and Adolescent Mental Health University of Erlangen\u2010Nuremberg  Erlangen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Eichler","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Mental Health University of Erlangen\u2010Nuremberg  Erlangen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Distler","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Mental Health University of Erlangen\u2010Nuremberg  Erlangen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y.","family":"Golub","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Mental Health University of Erlangen\u2010Nuremberg  Erlangen Germany"},{"name":"Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy JW Goethe University Hospital  Frankfurt am Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O.","family":"Kratz","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Mental Health University of Erlangen\u2010Nuremberg  Erlangen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.H.","family":"Moll","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Mental Health University of Erlangen\u2010Nuremberg  Erlangen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,12,16]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psyneuen.2009.12.007"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psyneuen.2014.02.014"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10802-016-0147-7"},{"key":"e_1_2_7_5_1","volume-title":"Beck\u2010Depressionsinventar II (BDI\u2010II)","author":"Beck A. 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