Improved treatment for PTSD

Traumatic experiences can leave scars in a person’s mind long after the events. Researchers in Linköping recently published results that give hope that drugs can improve the effect of psychological treatment of post-traumatic stress disorder, PTSD.

Professor Markus Heilig och förste forskningsingenjör Leah Mayo. Bilder tagna till artikel i tidningen Forskning och utveckling.Leah Mayo has led a study that showed that a new medication may improve the effects of psychological treatment of PTSD. Photo credit Anna NilsenMarkus Heilig is known mainly as one of Sweden’s leading experts in dependency disorders. But dependency does not exist in a vacuum. Post-traumatic stress disorder, a condition that arises in certain people who experience life-threatening events, is remarkably often part of the overall picture. Around half of patients with PTSD develop dependency.Professor Markus HeiligProfessor Markus Heilig. Photo credit Anna Nilsen

“This is a major clinical problem. In the healthcare system, we seldom discover that a patient has these problems together, since we don’t actively look for them as a pair in people who seek help for one of them. Or maybe we assume that PTSD can’t be treated in a patient with a dependency problem, and vice versa. People with these twinned problems are often shuttled from one place to another in the system. This is a bad idea, because both conditions must be treated at the same time”, says Markus Heilig, professor of psychiatry and director of the Center for Social and Affective Neuroscience (CSAN) at Linköping University.

The COPE method, a psychological approach to dealing with PTSD and substance dependency, is now being used in Stockholm. Research by Åsa Magnusson, in which Linköping researchers have also participated, has shown that the method works well.

The twinning of the two conditions led to Markus Heilig becoming interested in another question: how are we influenced by trauma experienced early in life? A collaboration with the Elefanten Child and Adolescent Psychiatry unit in Östergötland, which receives children and young people who have been subject to abuse, has led to unique opportunities. In a study led by consultant Andrea Capusan, the researchers are investigating, among other things, whether early trauma causes people to be particularly vulnerable to develop dependency.

Markus Heilig is not satisfied with research that only increases understanding of how people’s mind work.

“No – we want our research to lead to better treatment, as well. There is a huge need for treatments for PTSD, and PTSD when it’s combined with dependency.”

The best treatment currently available is exposure therapy. With the support of a therapist, the patient is exposed on repeated occasions to the traumatic memories. This helps the patient to relearn, such that the memories are no longer associated with acute danger. Exposure therapy can be used in care, but its effects are limited. Many patients are not helped by the treatment, and many of those who are helped find that the fear eventually returns.

The research group recently presented results from an experimental study showing that drug treatment has promising effects on the brain’s ability to forget frightening memories when the memories are no longer meaningful. The study was led by postdoc Leah Mayo, who was recruited to CSAN from the University of Chicago.Leah Mayo, förste forskningsingenjör IKE Leah Mayo, postdoc. Photo credit Anna Nilsen

“We have used a medicine that blocks the breakdown of some substances in the body that resemble cannabis, known as ‘endocannabinoids’. Our study showed that this category of drug, known as ‘FAAH inhibitors’, may make it possible to treat PTSD, and other stress-related psychiatric conditions, in a new way”, says Leah Mayo.

The study was carried out on healthy subjects, who were assigned at random to one of two groups: one that received an experimental drug, the other placebo. The drug raises the levels of the body’s own cannabis-like substances in the parts of the brain that control fear and anxiety.Genom att mäta aktiviteten i små ansiktsmuskler detekterar forskarna om försökspersonen reagerar med obehag, glädje, förvåning eller andra känslor i experimentet.Electrodes attached to small facial muscles allow the researchers to measure the emotional reactions of the subject, even if he or she is not conscious of them. Photo credit Anna Nilsen

The participants underwent 10 days of treatment, then were given several psychological and physiological tests. In one of the tests, the participants learned to associate a very unpleasant sound with a specific visual signal. After this, the learned fear was eradicated in a manner similar to that used in exposure therapy for PTSD.

“It was much easier for the participants who had received FAAH inhibitors to remember that the learned fear had been eradicated by training. This is a very exciting result”, says Leah Mayo.

“Many promising treatments that are the result of basic research into psychiatric conditions have not been successful when tested on humans. This is the first mechanism for a long time where promising results from animals appear to succeed also when tested in humans. The next step, of course, is to investigate whether the treatment works in people with PTSD”, says Professor Markus Heilig.

Translated by George Farrants

The article has been published (in Swedish) in Forskning & Utveckling 2/19

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