Cortisol and anxiety: what is known, and what isn't

Anxiety is not a cortisol disorder, but cortisol is part of the body’s stress response, so people reasonably ask whether the two are connected. They are, in the sense that studies find cortisol patterns that differ in some groups of people with anxiety and mood conditions. What those studies haven’t shown is that a cortisol level causes anxiety.

This page covers what the research found, where it conflicts, and what a cortisol result can and can’t tell you about how you feel.

What anxiety is, and what causes it

MedlinePlus describes anxiety as a feeling of fear, dread and uneasiness that can be a normal reaction to stress. In anxiety disorders the anxiety doesn’t go away and can get worse over time. The types include generalized anxiety disorder, panic disorder and phobias. It says the cause of anxiety is unknown, and that genetics, brain biology and chemistry, stress and your environment may play a role. Some physical health conditions, such as thyroid problems, are also listed as risk factors.

That last point is why a provider may order lab tests when you report anxiety symptoms. MedlinePlus says tests are done to make sure a different health problem isn’t the cause.

What studies find about cortisol and anxiety

A 2020 review in Frontiers in Psychiatry says the HPA axis, the stress system that ends in cortisol release, has been found overactive in certain subgroups of people with anxiety and mood disorders. It describes high cortisol in some studies of panic disorder and generalized anxiety disorder, and says it was not seen in other generalized anxiety studies. For PTSD it describes decreased HPA activity (Front Psychiatry, 2020).

The PTSD picture is mixed in a second source. A systematic review of hair cortisol in 31 studies found higher cortisol in people with recent or ongoing trauma. For trauma further in the past, results were less clear, with some studies finding lower cortisol, and the authors say the reasons are probably methodological (Curr Neuropharmacol, 2023).

Depression, which often occurs with anxiety, shows the same split. A 2023 review in Cells describes a large cohort in which people with current or past major depression had a higher cortisol rise after waking than people without it, though the difference was modest. It also describes a study that found depressive symptoms linked to both an overactive and an underactive HPA axis, and it says the results of studies of daily cortisol patterns in major depression have been inconsistent (Cells, 2023).

Does cortisol cause anxiety?

Nothing in these sources shows that. They compare groups, and they can’t say whether a cortisol difference came before the anxiety, followed from it or came from something else, such as poor sleep, medicines or the way a study was run.

Two medical conditions are different, because the cortisol problem is the diagnosis:

• Too much cortisol over a long period (Cushing’s syndrome). NIDDK lists depression or other mood changes, and memory loss or trouble concentrating, among its complications. The condition is rare, with an estimated 40 to 70 cases per million people for the kind caused inside the body, and it comes with physical signs such as easy bruising and wide purple stretch marks. See high cortisol.
• Too little cortisol (adrenal insufficiency). NIDDK lists irritability and depression among the symptoms, along with long-lasting fatigue, muscle weakness, weight loss and loss of appetite. See low cortisol.

Feeling anxious on its own is not a sign of either.

Questions people ask

Is there a link between cortisol and depression?

There is an association in some studies, as above, and the direction of the link isn’t established. The two hormone conditions listed above include depression among their symptoms.

What about cortisol and ADHD?

A 2021 meta-analysis of 19 case-control studies in youth found lower cortisol in children and teens with ADHD than in peers without it. This included lower cortisol in the morning and no difference in the afternoon. It compared groups and covered young people only. It doesn’t show that cortisol causes ADHD, and it can’t be used to diagnose it (Transl Psychiatry, 2021).

Does morning anxiety mean a cortisol problem?

Cortisol normally rises in the early morning and peaks within 30 to 45 minutes after waking (Int J Mol Sci, 2025). The two overlap in time. None of the sources used here shows that the rise causes morning anxiety. See cortisol awakening response.

If my cortisol is high and I have anxiety, is it Cushing’s?

Not necessarily. MedlinePlus says high cortisol levels can come and go in some people, a pattern called pseudo-Cushing syndrome, and it names depression, anxiety, alcohol use disorder, poorly controlled diabetes and obesity as possible causes. Doctors have follow-up tests to tell the two apart, and NIDDK says no one test is perfect. That work belongs with a clinician.

Is low cortisol dangerous?

It can be. NIDDK says adrenal crisis, the most serious complication of adrenal insufficiency, can cause death if it isn’t treated right away. Most people with anxiety do not have adrenal insufficiency. The signs and the emergency symptoms are on the low cortisol page.

What a cortisol test can show

A cortisol test is used to help diagnose or rule out conditions that cause too much or too little cortisol. It is not used to diagnose anxiety, and a single result can’t diagnose or rule out Cushing’s syndrome or adrenal insufficiency. MedlinePlus says stress is one of the things that can change a cortisol result, so a worried person’s level on the day of the test may not be their usual level. Diagnosis of an anxiety disorder starts with your symptoms and medical history.

When to see a clinician

See a clinician if anxiety doesn’t go away, gets worse or interferes with daily life. A provider will ask about your symptoms and history, may examine you and run lab tests to look for other causes, and may refer you to a mental health professional.

Get help right away if stress or anxiety is making you feel you can’t cope, or you have thoughts of suicide. In the US, call or text 988, the 988 Suicide & Crisis Lifeline, or call 911 in an emergency.

If you also have symptoms that match a hormone condition, mention them. For too much cortisol, they include easy bruising, wide purple stretch marks, a rounded face and weak muscles. For too little, they include long-lasting fatigue, weight loss and dizziness on standing. Vomiting you can’t stop, fainting or severe weakness need urgent care.

If you take a steroid medicine or a medicine for anxiety or depression, don’t stop or change it because of what you read here. Ask your prescriber.