Emotion Regulatory Brain Function and SSRI Treatment in PTSD: Neural Correlates and Predictors of Change

Neuropsychopharmacology. 2016 Jan;41(2):611-8. doi: 10.1038/npp.2015.190. Epub 2015 Jun 26.

Abstract

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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Afghan Campaign 2001-
  • Brain / drug effects*
  • Brain / physiopathology
  • Brain Mapping
  • Cerebrovascular Circulation / drug effects
  • Cerebrovascular Circulation / physiology
  • Cognition / drug effects
  • Cognition / physiology
  • Emotions / drug effects*
  • Emotions / physiology
  • Humans
  • Iraq War, 2003-2011
  • Magnetic Resonance Imaging
  • Male
  • Neuropsychological Tests
  • Oxygen / blood
  • Paroxetine / adverse effects
  • Paroxetine / therapeutic use*
  • Selective Serotonin Reuptake Inhibitors / adverse effects
  • Selective Serotonin Reuptake Inhibitors / therapeutic use*
  • Severity of Illness Index
  • Stress Disorders, Post-Traumatic / drug therapy*
  • Stress Disorders, Post-Traumatic / physiopathology
  • Treatment Outcome
  • Veterans / psychology
  • War Exposure / adverse effects

Substances

  • Serotonin Uptake Inhibitors
  • Paroxetine
  • Oxygen