Details:

Alternative Title:
Biol Psychiatry
Personal Author:
DePierro, Jonathan ; Lepow, Lauren ; Feder, Adriana ; Yehuda, Rachel
DePierro, Jonathan ; Lepow, Lauren ; Feder, Adriana ; Yehuda, Rachel Less -
Description:
Many biological systems are altered in association with posttraumatic stress disorder (PTSD) and resilience. However, there are only few approved pharmacological treatments for PTSD, and no approved medications to enhance resilience. This article provides a critical review of select neurobiological findings in PTSD and resilience, and also of pharmacologic approaches that have emerged from this work. The medications summarized involve engagement with targets in the adrenergic, hypothalamic-pituitary-adrenal axis, and neuropeptide Y systems. Other highlighted approaches involve the use of ketamine and 3,4-methylenedioxymethamphetamine-assisted psychotherapy, which recently surfaced as promising strategies for PTSD, though the neurobiological mechanisms underlying their actions, including for promoting resilience, are not yet fully understood. The former approaches fall within the broad concept of "rational pharmacotherapy," in that they attempt to directly target dysregulated systems known to be associated with posttraumatic symptoms. To the extent that use of ketamine and 3,4-methylenedioxymethamphetamine promotes symptom improvement and resilience in PTSD, this provides an opportunity for reverse translation and identification of relevant targets and mechanisms of action through careful study of biological changes resulting from these interventions. Promoting resilience in trauma-exposed individuals may involve more than pharmacologically manipulating dysregulated molecules and pathways associated with developing and sustaining PTSD symptom severity, but also producing a substantial change in mental state that increases the ability to engage with traumatic material in psychotherapy. Neurobiological examination in the context of treatment studies may yield novel targets and promote a greater understanding of mechanisms of recovery from trauma.
Subject:
[+]
Article
Drug Therapy
Glucocorticoids
Humans
Hypothalamo-Hypophyseal System
Ketamine
MDMA
Neurobiology
Pharmacotherapy
Pituitary-Adrenal System
Psychotherapy
PTSD
Resilience
Resilience, Psychological
Stress Disorders, Post-Traumatic

Source:
Biol Psychiatry. 86(6):454-463
Pubmed ID:
31466562
Pubmed Central ID:
PMC6907400
Document Type:
Journal Article
Funding:
U01 OH010729/OH/NIOSH CDC HHS/United States ; U01 OH011473/OH/NIOSH CDC HHS/United States
U01 OH010729/OH/NIOSH CDC HHS/United States ; U01 OH011473/OH/NIOSH CDC HHS/United States Less -
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:97a1c9bd3c11a7d22306c330f72065bf16c217ce81d096cbd855333703790e91
File Type:

Supporting Files

• 	nihms-1061205.nxml	xml
  	NIHMS1061205-supplement-Supplemental_Materials.pdf	pdf

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