In the Pursuit of Personalizing PTSD Care

In a push to move beyond the “one-size-fits-all” treatment approach, some psychiatric clinical scientists are exploring avenues of neurophysiology that could potentially predict patients with posttraumatic stress disorder (PTSD) that will respond better to selective serotonin reuptake inhibitors (SSRIs). Currently, SSRIs are the first-line drug therapy for PTSD.

K. Luan Phan, M.D., believes that measuring brain activity during pharmacotherapy treatment may be the first step in bringing care for posttraumatic stress disorder into the age of personalized medicine.

University of Illinois, Chicago

Using functional magnetic resonance imaging (fMRI), K. Luan Phan, M.D., chief of neuropsychiatric research at the Jesse Brown Veterans Affairs Medical Center and a professor of psychiatry at the University of Illinois, Chicago, found that activity levels in a specific region of the brain might be able to guide physicians to the best pharmacological options for treating veterans with PTSD. The findings appeared June 26 in Neuropsychopharmcology.

For the study, Phan and colleagues performed fMRI scans to detect regional brain activity in 34 veterans who returned from war in Afghanistan and Iraq, including 17 who had a diagnosis of PTSD in accordance with DSM-IV criteria. During scans at the start and end of the study 12 weeks later, veterans performed an emotion regulation task, a testing tool that induces emotional conflict while behavioral and/or physiological data are collected. All veterans with PTSD were treated with paroxetine, one of two FDA-approved SSRIs for PTSD, for the time period between the scans.

The researchers observed that patients who showed the most improvement from paroxetine treatment were those who had the least activation in the right ventrolateral prefrontal cortex—a region known to help with emotional regulation, impulse control, cognitive flexibility, and executive function—prior to treatment. Improvements observed in these patients were irrespective of the pretreatment severity of PTSD.

“The interpretation of these findings is that those veterans who have the most ‘deficient’ brain engagement during emotion regulation stand to gain the most from paroxetine treatment,” Phan told Psychiatric News. “Individual differences in brain dysfunction in this particular area may explain some of the variability in treatment response observed with SSRI treatment.”

However, Phan emphasized that more investigations, including large-scale studies and studies comparing various pharmacological and psychological treatments, are needed to confirm the current findings.

Sheila Raunch, Ph.D., director of the Serving Returning Veterans’ Mental Health Program at the VA Ann Arbor Health Care System and an expert in precision medicine for psychiatric disorders, agreed.

“Within [the realms of] PTSD, this research is in the early stages,” Rauch said in a press statement regarding the research efforts of Phan and colleagues. “We need larger studies that will allow replication and application to a treatment population,” and those generally take at least five years to implement and yield results, she added.

“This is a marathon and not a sprint. Expecting an overhaul in the next couple of years is unrealistic, but I do think that 10 years from now, PTSD care will be even more advanced and effective than it is today. We are moving in the right direction,” she concluded.

The current study was funded by the Department of Veterans Affairs’ Merit Review Program Award.

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K. Luan Phan

K. Luan Phan MD

Dr. K. Luan Phan is the UI CDR Endowed Professor, Director of the Mood and Anxiety Disorders Research Program (MADRP) and Associate Head for Clinical and Translational Research in the Department of Psychiatry at the University of Illinois at Chicago.  He is also Chief of NeuroPsychiatric Res ...

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