TY - JOUR
T1 - Emotion regulatory brain function and SSRI Treatment in PTSD
T2 - Neural correlates and predictors of change
AU - MacNamara, Annmarie
AU - Rabinak, Christine A.
AU - Kennedy, Amy E.
AU - Fitzgerald, Daniel A.
AU - Liberzon, Israel
AU - Stein, Murray B.
AU - Phan, K. Luan
N1 - Funding Information:
This material is based on work supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Clinical Sciences Research and Development, and the Veterans Affairs Merit Review Program Award, awarded to KLP. AM is supported by the National Institute of Mental Health grant T32MH067631-09. MBS has, in the past 3 years, received payment for his editorial work on the journals ‘Depression and Anxiety’ and ‘Biological Psychiatry,’ and on the evidence-based medical information source ‘Up-To-Date’. He has also been paid as a consultant by Janssen, Pfizer, and Tonix Pharmaceuticals, and by Care Management Technologies. AM, CAR, AEK, DAF, IL and KLP have no potential conflicts of interest to declare.
PY - 2016/1/1
Y1 - 2016/1/1
N2 - Posttraumatic stress disorder (PTSD) - a chronic, debilitating condition, broadly characterized by emotion dysregulation - is prevalent among US military personnel who have returned from Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF). Selective serotonin reuptake inhibitors (SSRIs) are a first-line treatment for PTSD, but treatment mechanisms are unknown and patient response varies. SSRIs may exert their effects by remediating emotion regulatory brain activity and individual differences in patient response might be explained, in part, by pre-treatment differences in neural systems supporting the downregulation of negative affect. Thirty-four OEF/OIF veterans, 17 with PTSD and 17 without PTSD underwent 2 functional magnetic resonance imaging scans 12 weeks apart. At each scan, they performed an emotion regulation task; in the interim, veterans with PTSD were treated with the SSRI, paroxetine. SSRI treatment increased activation in both the left dorsolateral prefrontal cortex (PFC) and supplementary motor area (SMA) during emotion regulation, although only change in the SMA over time occurred in veterans with PTSD and not those without PTSD. Less activation of the right ventrolateral PFC/inferior frontal gyrus during pre-treatment emotion regulation was associated with greater reduction in PTSD symptoms with SSRI treatment, irrespective of pre-treatment severity. Patients with the least recruitment of prefrontal emotion regulatory brain regions may benefit most from treatment with SSRIs, which appear to augment activity in these regions.
AB - Posttraumatic stress disorder (PTSD) - a chronic, debilitating condition, broadly characterized by emotion dysregulation - is prevalent among US military personnel who have returned from Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF). Selective serotonin reuptake inhibitors (SSRIs) are a first-line treatment for PTSD, but treatment mechanisms are unknown and patient response varies. SSRIs may exert their effects by remediating emotion regulatory brain activity and individual differences in patient response might be explained, in part, by pre-treatment differences in neural systems supporting the downregulation of negative affect. Thirty-four OEF/OIF veterans, 17 with PTSD and 17 without PTSD underwent 2 functional magnetic resonance imaging scans 12 weeks apart. At each scan, they performed an emotion regulation task; in the interim, veterans with PTSD were treated with the SSRI, paroxetine. SSRI treatment increased activation in both the left dorsolateral prefrontal cortex (PFC) and supplementary motor area (SMA) during emotion regulation, although only change in the SMA over time occurred in veterans with PTSD and not those without PTSD. Less activation of the right ventrolateral PFC/inferior frontal gyrus during pre-treatment emotion regulation was associated with greater reduction in PTSD symptoms with SSRI treatment, irrespective of pre-treatment severity. Patients with the least recruitment of prefrontal emotion regulatory brain regions may benefit most from treatment with SSRIs, which appear to augment activity in these regions.
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U2 - 10.1038/npp.2015.190
DO - 10.1038/npp.2015.190
M3 - Article
C2 - 26111649
AN - SCOPUS:84949575429
SN - 0893-133X
VL - 41
SP - 611
EP - 618
JO - Neuropsychopharmacology
JF - Neuropsychopharmacology
IS - 2
ER -