EMORY RESEARCHERS FIND PAXIL IMPROVES MEMORY & BRAIN STRUCTURE IN POST-TRAUMATIC STRESS DISORDER SUFFERERS

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EMORY RESEARCHERS FIND PAXIL IMPROVES MEMORY & BRAIN STRUCTURE IN POST-TRAUMATIC STRESS DISORDER SUFFERERS
11 September 2005 - Emory University

Emory University researchers have found that paroxetine HCL (Paxil) produces measurable improvement in verbal memory and also increases the size of the hippocampus, a key area of the brain involved in learning and remembering, in persons suffering from post-traumatic stress disorder.

Their study, which will be published in the Biological Psychiatry, also found that Paxil significantly reduces the three main symptom clusters of PTSD, re-experiencing the traumatic event; avoidance and emotional numbing related to experiences that recall the traumatic event; and hyperarousal at inappropriate times.

The study was directed by J. Douglas Bremner, MD, associate professor in the Department of Psychiatry and Behavioral Sciences and the Department of Radiology at the Emory University School of Medicine, and Director of Mental Health Research at the Atlanta Veteran's Affairs Medical Center. Eric Vermetten, MD, former research fellow in the Emory Psychiatry Department and now at the University of Utrecht in The Netherlands, was first author of the study. The study, conducted over a 12-month period, was based on 23 persons who suffered with PTSD from a variety of causes, most commonly childhood abuse.

"Many patients with post-traumatic stress disorder suffer impaired memory, often leading them to experience distorted or fragmented memories of the traumatic event. In addition, PTSD patients suffer from problems with new learning and memory as well as concentration," said Dr. Bremner. "The findings of this study indicate that Paxil may help reverse memory loss and increase hippocampal volume, leading to clinically significant improvements in memory and concentration that will improve their work and social function. It may also be true that improved memory will help trauma survivors re-integrate and work through memories of their own traumatic events."

Previous studies have demonstrated that patients with PTSD suffer a decrease in volume of the hippocampus, as well as deficits in hippocampal-based learning and memory as measured with neuropsychological testing. Some studies have associated high levels of cortisol, a hormone that regulates stress, with negative effects on this area of the brain. Studies in animals have also shown that medications such as Paxil have a beneficial effect on the growth and structure of hippocampal neurons.

The study participants were all residents of the state of Connecticut. The patients took 10-50 mg of Paxil (average 20 mg), and were evaluated at the end of 36 weeks. No psychotherapeutic procedure was administered in the study phase, except for supportive therapy. Hippocampal volume was assessed by MRI before and after treatment. Stress parameters and measures of declarative memory function were also evaluated.

Patients in the study experienced significant improvement in verbal declarative memory functions and retention, a four percent increase in the right hippocampus, which affects visual/spatial functioning, and a 5.2 percent increase in their left hippocampus, which controls verbal functioning; decreased cortisol levels, a stress regulator, in the brain; and significant relief of each of the three major symptom clusters of PTSD.

"These study findings reinforce that post-traumatic stress disorder is caused by biologic changes in the brain, and that medications like Paxil play a neurobiologic role in its treatment," added Dr. Bremner. "This data provides clinicians with insight into the complicated nature of treating PTSD, and the importance of effective treatments."

Affecting up to 16 million Americans, PTSD is a debilitating condition that develops after experiencing or witnessing a traumatic event. Of people exposed to traumatic events, as many as 15 percent will develop PTSD. Traumatic events can include car accidents, natural disasters, physical or sexual assault, terrorist attack and robbery. To be diagnosed with PTSD, people must experience intense fear, helplessness or horror and experience each of the three main symptom clusters for more than one month post-exposure to the trauma.

Funding for the study was provided by GlaxoSmithKline, National Institute of Mental Health and the National Center for PTSD. Co-authors include Meena Vythilingam, MD and Dennis S. Charney, MD, Program for Mood and Anxiety Disorders, National Institute of Mental Health; and Steven M. Southwick, MD, Department of Psychiatry, Yale University School of Medicine.

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Emory University is home to nine major academic divisions, numerous centres for advanced study, and a host of prestigious affiliated institutions. In addition to Emory College, the University encompasses a graduate school of arts and sciences; professional schools of medicine, theology, law, nursing, public health, and business; and Oxford College, a two-year undergraduate division on the original campus of Emory in Oxford, Ga.

Emory was founded at Oxford by the Methodist Church in 1836. Led by President James W. Wagner, an award-winning teacher and scholar, the University has 11,300 students and 2,500 faculty members who represent all regions of the United States and more than 100 foreign nations.

Emory University is known for its demanding academics, outstanding undergraduate college of arts and sciences, highly ranked professional schools and state-of-the-art research facilities. For more than a decade Emory has been named one of the country's top 25 national universities by U.S. News & World Report. In addition to its nine schools, the university encompasses The Carter Center, Yerkes National Primate Research Center and Emory Healthcare, a comprehensive metropolitan health care system.

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