Living with PTSD

Brain Stimulator Treats Resistant Depression

Electrically stimulating the brain can dramatically alleviate depression resistant to other treatments.

The findings come from a small study of six people. But they are significant, say the study's authors, because up to 20% of people with depression don't respond to standard treatments and require a combination of such things as antidepressants and electroconvulsive treatment that still may fail.

Link: Betterhumans > Brain Stimulator Treats Resistant Depression.

GAO Questions VA's Ability To Provide More PTSD Care -- Mulligan 39 (22): 12 -- Psychiatric News

Will veterans returning home from Iraq receive prompt and effective treatment for their war-related mental health disorders?

Neither the Department of Veterans Affairs (VA) nor the Department of Defense (DoD) can provide a definitive answer, according to a recent report from the Government Accountability Office (GAO).

The report, released September 20, offered recommendations that would lead to improved data collection and coordination between the two governmental agencies.

Link: GAO Questions VA's Ability To Provide More PTSD Care.

On the Analyst's Couch With Ecstasy

Link: On the Analyst's Couch With Ecstasy.

A handful of intrepid shrinks are hoping to bring the club drug MDMA back to its psychotherapeutic roots by using it in therapy sessions (and yes, it's still illegal).

Forgotten Casualties

Mike Lemke, a 45-year-old Army National Guard police sergeant from Colorado Springs, Colo., volunteered for active duty after seeing the twin towers fall on TV. "I wanted to, you know, kick some tail," he says. He was sent home from Iraq in August 2003 because of orthopedic and cardiovascular problems -- and with memories and feelings he couldn't shake. He'd seen what was left of one of Saddam's prisons, prowled by feral dogs with rotting limbs in their mouths; he'd mingled constantly with civilians, never knowing if one was armed. "You never feel completely safe," he says. "That stays with you."

Lemke could not sleep for his first 22 days in the medical barracks in Colorado's Fort Carson, where he remained for more than a year on "medical holdover" -- a period during which wounded soldiers await treatment and subsequently either return to duty or get a medical exit from the Army. He experienced flashbacks and temper surges and would hit the dirt at the sound of a jackhammer.

No one approached Lemke to inquire about his mental health. Only when a nurse practitioner happened to ask him how he was sleeping did the story come out -- and even then it took him two weeks to accept her suggestion that he seek counseling.

Link: Forgotten Casualties.

Mimicking Brain's 'All Clear' Quells Fear in Rats

Researchers funded by the National Institute of Mental Health (NIMH) have discovered a high tech way to quell panic in rats. They have detected the brain's equivalent of an "all clear" signal, that, when simulated, turns off fear. The discovery could lead to non-drug, physiological treatments for runaway fear responses seen in anxiety disorders.

Rats normally freeze with fear when they hear a tone they have been conditioned to associate with an electric shock. Dr. Gregory Quirk and Mohammed Milad, Ponce School of Medicine, Puerto Rico, have now demonstrated that stimulating a site in the front part of the brain, the prefrontal cortex, extinguishes this fear response by mimicking the brain's own "safety signal." They report on their findings in the November 7, 2002 Nature.

"Repeated exposure to traumatic reminders without any adverse consequences causes fear responses to gradually disappear," explained Quirk. "Such reduction of fear appears to be an active rather than passive process. It doesn't erase the fear association from memory, but generates a new memory for safety."

The researchers recorded electrical activity of neurons in the prefrontal cortex as rats were fear-conditioned—taught to fear a tone by repeatedly pairing it with a shock. Then they abolished this conditioned fear by presenting the tone without the shock; the animals no longer froze when they heard the tone.

Although inactive during both procedures, neurons near the middle of the prefrontal cortex, the infralimbic area, fired conspicuously when the tone was sounded on the following day. This activity proved to be the brain's way of signaling that the tone no longer presaged a shock. The more the cells fired—i.e., the louder this safety signal—the less the rats froze. Animals that showed the most infralimbic activity behaved as if they had never been fear conditioned at all.

The researchers then electrically stimulated the infralimbic area in rats that had been fear conditioned but not extinguished—in effect simulating the safety signal, while pairing it with the tone. Remarkably, the rats showed little freezing. Later, the rats continued to be unafraid of the tone even without the stimulation, suggesting that memory for extinction was strengthened by experimentally mimicking the safety signal.

Since the prefrontal cortex is known to project to the amygdala, a hub of fear memory deep in the brain, the researchers propose that increased activity of infralimbic neurons in the prefrontal cortex strengthens memory of safety by inhibiting the amygdala's memory of fear. They speculate that stimulating parts of the prefrontal cortex in anxiety disorder patients, using an experimental technique called transcranial magnetic stimulation, might help them control fear.

Link: Mimicking Brain's 'All Clear' Quells Fear in Rats.

Sex Hormone Metabolite Reduces Stress, Anxiety In Female Rats

A steroid hormone released during the metabolism of progesterone, the female sex hormone, reduces the brain's response to stress, according to research in rats by scientists at Emory University School of Medicine, the Yerkes National Primate Research Center and Atlanta's Center for Behavioral Neuroscience. The scientists found evidence that the progesterone metabolite allopregnanolone reduces the brain's response to corticotropin-releasing factor (CRF), a peptide hormone that plays an important role in the stress response in animals. The finding, which was reported in the Nov. 10, 2004 edition of the Journal of Neuroscience, could provide a new drug target for treating anxiety and depression in women.

Link: Sex Hormone Metabolite Reduces Stress, Anxiety In Female Rats.

Ecstasy trials for combat stress

Link: Ecstasy trials for combat stress.

American soldiers traumatised by fighting in Iraq and Afghanistan are to be offered the drug ecstasy to help free them of flashbacks and recurring nightmares.

The US food and drug administration has given the go-ahead for the soldiers to be included in an experiment to see if MDMA, the active ingredient in ecstasy, can treat post-traumatic stress disorder.

Scientists behind the trial in South Carolina think the feelings of emotional closeness reported by those taking the drug could help the soldiers talk about their experiences to therapists. Several victims of rape and sexual abuse with post-traumatic stress disorder, for whom existing treatments are ineffective, have been given MDMA since the research began last year.

Protective relationship protects women from major depression more than men, VCU study

Virginia Commonwealth University researchers have found that women who feel more loved and supported by their friends, relatives and children are less at risk for major depression than men, suggesting important gender differences in the pathways leading to depression.

Link: Protective relationship protects women from major depression more than men, VCU study.

Vitamin E status, role in depression?

People with depression appear to have lower levels of the vitamin E alpha-tocopherol circulating in their bloodstream, report researchers, who will investigate further whether vitamin E supplements can help their symptoms.

Link: Vitamin E status, role in depression?.

Sex hormone metabolite reduces stress, anxiety in female rats

ATLANTA-- A steroid hormone released during the metabolism of progesterone, the female sex hormone, reduces the brain's response to stress, according to research in rats by scientists at Emory University School of Medicine, the Yerkes National Primate Research Center and Atlanta's Center for Behavioral Neuroscience. The scientists found evidence that the progesterone metabolite allopregnanolone reduces the brain's response to corticotropin-releasing factor (CRF), a peptide hormone that plays an important role in the stress response in animals. The finding, which was reported in the Nov. 10, 2004 edition of the Journal of Neuroscience, could provide a new drug target for treating anxiety and depression in women.

In the study, Emory researchers Donna Toufexis, PhD, Michael Davis, PhD and Carrie Davis, BS, and Alexis Hammond, BS, of Spelman College, compared how female rats with different levels of the sex hormones, estrogen and progesterone, reacted to loud noises after injections of CRF into the brain's lateral ventricles. CRF injections usually increase the "acoustic startle response" in this test used to gauge stress and anxiety, a phenomenon called CRF-enhanced startle.

In the first experiment, the scientists compared acoustic startle responses after CRF injection in an estrogen-only group, an estrogen-plus-progesterone group and a control group that did not receive any sex hormones. All the rats lacked ovaries and the ability to produce sex hormones naturally. Acoustic startle response was unaffected in the estrogen-only group and the control group. In the estrogen-plus-progesterone group, however, CRF-enhanced startle was significantly lower than in the other groups.

In another set of experiments, the researchers discovered that lactating female rats with naturally high levels of progesterone had markedly lower CRF-enhanced startle responses compared to virgin females with intact ovaries. "Findings from theses initial experiments pointed toward the conclusion that progesterone inhibits the effect of CRF on the acoustic startle response," said Toufexis.

To test this hypothesis, the researchers gave only progesterone to female rats lacking ovaries, then compared the acoustic startle response to female rats without ovaries injected with corn oil. The progesterone group displayed significantly lower CRF-enhanced startle responses. When ovariectomized females were tested with allopregnanolone alone it also reduced CRF-enahnced startle.

In a final experiment, the scientists compared the effects on females that received progesterone with those that received medroxy-progesterone, an artificial progestin that binds to progesterone receptors but does not metabolize into the progesterone metabolite allopregnanolone. Only natural progesterone reduced CRF-enhanced startle.

Previous studies have determined that allopregnanolone enhances the activity of GABA, the main inhibitory neurotransmitter in the central nervous system, at its receptors throughout the brain. This mechanism, Toufexis said, likely accounts for progesterone's blunting effect on the brain's stress system.

Findings from the study correlate with clinical evidence that some people suffering from depression or anxiety have low allopregnanolone levels that normalize after treatment with anti-depressant medications.

"New drugs could potentially be developed that mimic the effect of allopregnanolone on the GABA receptor, providing a new approach for controlling mood disorders in women," said Toufexis. "The next step is to determine where exactly allopregnanolone is working in the brain to reduce the effect of CRF."

###

The research was supported by the Center for Behavioral Neuroscience through the National Science Foundation, by the National Institute of Mental Health, and by the Woodruff Foundation