Researchers studying ancient texts from Mesopotamia dating to 1300 BCE came across descriptions of symptoms that sound remarkably similar to post-traumatic stress disorder, or PTSD. As such, this may be the earliest depiction of PTSD in history.
The findings were reported in the journal Early Science and Medicineby Walid Khalid Abdul-Hamid of Queen Mary University of London and Jamie Hacker Hughes of the Veterans and Families Institute at Anglia Ruskin University. Speaking to BBC News, the researchers said that the Assyrian soldiers “described hearing and seeing ghosts talking to them, who would be the ghosts of people they’d killed in battle – and that’s exactly the experience of modern-day soldiers who’ve been involved in close hand-to-hand combat.”
Nothing new under the sun
According to the researchers, professional soldiers enlisted by the Assyrian Dynasty in Mesopotamia, present-day Iraq, between 1300BC and 609BC first went through a year-long bootcamp, which also involved civil works like building roads, bridges, and other infrastructure for the kingdom. The soldiers were then sent to war for a year and, if they made it back in one piece, they were allowed to return their families for one year before repeating the cycle again.
But as the ancient texts analyzed by the researchers showed, although their bodies might have come back home intact, some of the soldiers’ minds were in shatters.
PTSD has only fairly recently been formally described by psychiatrists, after studies of Vietnam war veterans. Previously, doctors simply dismissed PTSD symptoms in soldiers as ‘shell shock’ or ‘battle fatigue’.
“Ancient soldiers facing the risk of injury and death must have been just as terrified of hardened and sharpened swords, showers of sling-stones or iron-hardened tips of arrows and fire arrows. The risk of death and the witnessing of the death of fellow soldiers appears to have been a major source of psychological trauma,” the paper reads. “Moreover, the chance of death from injuries, which can nowadays be surgically treated, must have been much greater in those days. All these factors contributed to post-traumatic or other psychiatric stress disorders resulting from the experience on the ancient battlefield.”
Until now, the oldest reference to PTSD-like symptoms came from ancient Greece, in texts by Herodotus describing the aftermath of the infamous Battle of Marathon in 490 BCE. Herodotus claimed that some Athenian warriors had hallucinations and suffered from spontaneous blindness following their close encounter with death on the battlefield. Achilles, hero of the Trojan war, is commonly held to be an ancient sufferer of PTSD as well. And in one potential account of PTSD, one chronicler described the crusaders coming home from the Third Crusade (1189-92), writing that though these men “survived unharmed … their hearts were pierced by swords of sorrows from different sorts of suffering”.
Although PTSD is challenging (and sometimes impossible) to diagnose from text alone, these accounts show that trauma and distress haunted veterans likely since humans first waged war on one another.
More than 8 million people suffer from post-traumatic stress disorder (PTSD) in the United States alone, which is often accompanied by depression, angst, addiction, and poor social integration. Among the hardest cases, PTSD often leads to suicide. Existing therapies have a poor response rate, which is why some researchers are looking into experimental procedures meant to alter or even erase traumatic memories in order to cure the disorder.
The first trials in this direction can be traced to 2004, when scientists gave mice a drug called propranolol that, under certain conditions, caused the animals to ‘forget’ nasty memories that were causing trauma. But subsequent work was not able to replicate these promising results. Now, researchers at Cambridge University think they know why.
The British researchers identified a specific protein, which they refer to as a “shank” protein, whose presence determines whether or not traumatic memories can be altered with ease.
“In ancient Greek legend, they spoke of a drug, Nepenthe, which made them forget painful memories,” said lead author Dr. Amy Pelton in a statement. “We hope that this is a step on the path to treatment.”
There are two types of long-term memories. There’s fact-based memory which can retrieve useful information such as names, places, events, what’s Newton’s first law of motion, and so on. The other distinct type of memory pertains to skills and emotions. Vivid emotional memories can trigger the same kinds of emotional states — for better or worse — as those experienced during the time they were etched in our cortex. In the case of PTSD-causing memories, these can be replayed ad nauseam and at the most unpredictable moments, making life unbearable.
In 2004, researchers at the Center for Neural Science at New York University showed that mice treated with the beta-blocker propranolol were able to overcome a learned trauma. This drug targets emotional memories allowing their disruption.
But Pelton and colleagues found that memory alteration is, understandably, far more complex than meets the eye. Their research shows that a particular protein can be used as a brain marker that indicates whether or not emotional memories are alterable.
For their own experiments, the researchers trained rats to associate a clicker (the kind used in dog training) with a mild electric footshock, a type of fear conditioning. Eventually, every time the rat heard the clicker, they shivered expecting mild pain, just like Pavlov’s dogs drooled when they heard the bell sound they associated with a treat more than a hundred years ago.
Immediately after the clicker reactivated the bad memory, the rats were injected with propranolol. However, the rats continued to react in fear at the clicky sound. If the study ended here, the researchers could have concluded, like others before them, that the original 2004 study was unreplicable.
The scientist dug deeper, though, finding that the “shank” protein acts as a scaffold for receptors in the brain that control connections between the neurons. This protein has to be degraded in order for a particular memory to become malleable. If the protein is intact, the “memories were not degradable, explaining why propranolol does not always produce amnesia,” the authors wrote in their study that was presented at the 34th ECNP Annual conference in Lisbon.
While they were not able to erase traumatic memories in rats, the findings bring us a step closer to achieving this lofty goal. Many other challenges remain, including the complex nature of the human brain. Transferring the same fear-response alterations in rodents to humans may prove unviable.
“We don’t see this leading to the sort of situation shown in the movies, like, for example, ‘Eternal Sunshine of the Spotless Mind,’ where the protagonists can choose which memories to erase,” said Pelton. “But we hope that over time we will be able to identify the factors that make memories modifiable in animals and translate these to human patients.”
Elsewhere, other research groups are exploring other avenues of emotional memory alteration. MIT neuroscientists have proposed erasing old traumatic memories with fresh, same ones by employing drugs that activate certain genes.
MDMA, short for 3,4 methylenedioxymethamphetamine, is a psychoactive drug whose effects can resemble those of both stimulants and psychedelics. The drug is known to produce distortions in time and perception, enhance the enjoyment of sensory experiences, and make people feel more energized. Its defining feature is that it increases self-awareness and empathy, which together enable a feeling of connectedness that many users report.
In its tablet or capsule form, MDMA is known as Ecstasy, whereas Molly — slang for ‘molecule’ or ‘molecular’ — refers to the crystalline powder form of MDMA. However, both versions may contain a number of other drugs that can be harmful and even life-threatening. In fact, sometimes drugs sold as Ecstasy or Molly do not even contain MDMA, which is replaced by other stimulants such as methylone or ethylone. Ecstasy tablets purchased on the street are often adulterated with methamphetamine, ketamine, caffeine, ephedrine, cocaine, phencyclidine (PCP), or over-the-counter cough suppressants such as dextromethorphan.
MDMA is one of the most popular recreational drugs in the world. The drug is often associated with raves and the party scene, although recently many people in their late 30s and 40s have started using MDMA at home due to its anxiety-relieving effects. In fact, the role of MDMA in clinical practice is going through a revival thanks to recent research showing it can treat post-traumatic stress disorder (PTSD), anxiety, and addiction. In 2017, the Food and Drug Administration (FDA) granted breakthrough therapy status to MDMA-assisted psychotherapy.
MDMA was first developed by the German pharmaceutical giant Merck in 1912. Initially, MDMA was known as “Methylsafrylaminc,” a precursor compound that the company used to synthesize medications designed to control bleeding.
For decades the drug was little known until it started gaining a small following among psychiatrists in the 1970s and early 1980s who recognized its therapeutic value by making patients more communicative and open about their problems. It’s worth noting that Alexander Shulgin, an American chemist and pharmacologist affiliated with the University of San Francisco, was the linchpin of MDMA research during these early days.
Shulgin was first introduced to MDMA in 1976 by one of his students at a course he was teaching at the time at San Francisco State University. The American chemist went on to develop a new synthesis method that made it much easier to make MDMA. He then went on to introduce the chemical to psychologists in California, which then spread to hundreds of psychologists and lay therapists around the nation who found small doses of MDMA greatly aided talk therapy. Some therapists called the drug ‘Adam’ since they believed MDMA helped patients return to a more innocent, primordial state.
The CIA took note as well and experimented with MDMA, along with other hallucinogenic drugs like LSD, as part of its MK-Ultra project that sought to assess whether psychedelics could be used for ‘mind control’. Although this secret project is notorious for testing psychedelic drugs on unwitting subjects, classified reports suggest that the CIA only used MDMA on non-human subjects. These experiments produced the first known toxicology studies on MDMA — given the codename EA-1475.
It was also around this time that MDMA started becoming widely available on the street. Eventually, the DEA banned MDMA in 1985 under its ‘War on Drugs’ policy, placing it on the list of Schedule I substances — along with LSD, heroin, and marijuana — that supposedly have no currently accepted medical use and a high potential for abuse. To this day, MDMA is still classed as a Schedule I drug. Most of the MDMA in the U.S. is synthesized in clandestine labs in Canada and the Netherlands.
What are the effects of MDMA
It takes around 15 minutes for MDMA to circulate through the bloodstream and reach the brain, where it leads to psychoactive effects similar to both a stimulant and hallucinogen. These effects typically last three to six hours.
MDMA is classed as an empathogen, meaning it increases a user’s feeling of empathy and compassion towards others. The main action of MDMA in the brain is that it increases serotonin, the neurotransmitter that, among other things, is responsible for regulating prosocial behavior, empathy, and optimism.
However, too much serotonin in the brain can trigger “serotonin syndrome”, which especially happens when MDMA is taken together with other drugs such as alcohol, amphetamines, or cocaine.
Some of the most common side effects of MDMA include euphoria, feeling energetic, dilated pupils, jaw clenching and teeth grinding, excessive sweating and skin tingles, muscle aches and pains, reduced appetite, accelerated heartbeat, high blood pressure, dehydration, and heatstroke.
Overdosing on MDMA or simply taking repeated doses of the drug over a long time can cause visual and auditory hallucinations, irrational behavior, anxiety, irritability, paranoia, vomiting, high body temperature, racing heartbeat, convulsions.
After the MDMA high wears off, most users will experience a 24- to 48-hour period during which they may feel lethargic, have a low appetite, or experience a state of unease or generalized dissatisfaction with life (dysphoria, or the opposite of euphoria). Colloquially, this unpleasant period is known as “suicide Tuesday”, a reference to the fact that the crash happens after a heavy weekend of partying.
Tolerance of MDMA sets in rapidly, making users chase the euphoric effects with repeated doses. But rather than reaping the desirable effects, users who abuse MDMA and have high tolerance typically wind up experiencing more of the sympathomimetic effects, placing them at risk for cardiovascular instability, arrhythmias, and hyperthermia. Long-term abuse of MDMA can result in depression, memory and concentration problems, and liver problems.
Long-term use of MDMA can also cause dependence, although it is exceedingly rare compared with other highly addictive drugs such as cocaine or alcohol. Less than 1% of patients seeking drug treatment at clinics in Australia are for ongoing problems related to MDMA. MDMA is described as a “self-limiting” drug as the intensity of the positive effects decreases with increased use, while negative effects increase.
The spikes in blood pressure and heart rate can be dangerous for people with underlying cardiovascular problems. But perhaps the greatest risk of MDMA is that it raises body temperature, especially since its use is often accompanied by strenuous physical activity (such as dancing) in a hot environment such as a crowded venue or in the summer heat. This combination exacerbates fluid loss, which further interferes with the body’s ability to cool itself properly.
In the early 2000s, some public officials went on a crusade against ecstasy, which they nicknamed “agony”. Some warnings included that MDMA use can lead to Parkinson’s disease, a lifetime of depression, and even “holes in your brain”. Dr. John Halpern, a psychiatrist at Harvard University, thoroughly debunked these claims finding no evidence that ecstasy users have decreased cognitive performance.
The effects of MDMA can also vary because ecstasy and molly are often tainted with other substances, which have their own psychoactive effects when used alone or in combination with MDMA. Purchasing illegal substances off the street or in nightclubs is always a gamble because you can never be sure what’s inside. In 2018, a pill testing trial at a major music festival in Australia found that nearly half the pills tested were of low purity. Some 84% of people who had their pills tested thought they had bought MDMA but only 51% actually contained any MDMA. On the other end of the spectrum, pill tests in the UK and New Zealand have sometimes found up to three doses of MDMA in a single pill.
People have died as a result of taking MDMA, although the number of deaths is relatively low compared to other drugs such as heroin, alcohol, and pharmaceuticals. Most of the deaths are not directly from the drug itself but as a result of other complications or contaminants. There were 92 MDMA-related deaths in England and Wales in 2018, up from 56 the year before, and 10,000 hospitalizations for MDMA-related illness/injury in 2011 in the US.
Water intoxication and MDMA
People taking on MDMA should drink around 500ml of water an hour if they’re active and half of this amount if inactive in order to combat the dehydration effects of the drug. However, it’s easy to go overboard especially due to overheating from the venue and the effects of MDMA itself.
Unlike alcohol, MDMA is an antidiuretic, meaning it makes you retain water. When you have too much water in your body, the ratio of salts and water can be thrown off balance. Cells can start swelling with water, and the body can suffer from water intoxication, a condition called hyponatremia. Symptoms include headache, vomiting, and confusion or seizures. In some cases, water intoxication can lead to death.
Ecstasy has long been associated with rave culture, particularly electronic dance music (EDM) events. Raves refer to all-night dance parties characterized by loud music and a psychedelic atmosphere.
But more recently, MDMA is seeing a resurgence as a therapeutic drug, particularly for PTSD. There hasn’t been a new, effective drug meant to treat PTSD in nearly 20 years, but promising clinical trials performed since the previous decade have shown that MDMA might greatly enhance therapy.
The treatment protocol involves pure MDMA ingested in pill form that is not adulterated with any other substances. Moreover, the drug is always taken under the supervision of a specially-trained therapist over the course of a 12-week program. During this time, the patient will experience 2-3 daylong sessions, each lasting roughly 8 hours.
Therapists say that MDMA heightens feelings of safety and social connections, allowing patients to revisit traumatic memories and process all the terrible things they went through without triggering the same panic.
Speaking to NPR, Saj Razvi, a Colorado-based psychotherapist who was a clinical investigator in the Phase 2 trials of an MDMA study for PTSD, said that these sessions can look almost like a “bad trip”. But although they may seem nerve-wracking, MDMA-assisted therapies lead to emotional breakthroughs that otherwise “may take months or years to accomplish”.
After this phase 2 trial of MDMA-assisted therapy concluded in 2017, researchers found that 54% of the patients who took the drug improved their symptoms to the point that they no longer fit the diagnosis for PTSD, compared to 23% for the control group. What was particularly staggering was that the positive effects appeared to increase, rather than wane, over time. One year after their therapy, 68% of the participants who took MDMA no longer had PTSD.
Although MDMA is still a schedule I substance in the United States, researchers are able to perform clinical trials with the drug thanks to private sponsors such as the Multidisciplinary Association for Psychedelic Studies (MAPS). The non-profit is now working to get the FDA on board in order to include MDMA in its expanded access program, which will allow patients to use MDMA.
Researchers are shedding new light on the origins of PTSD, post-traumatic stress disorder.
Post-mortem analysis of the brain tissue of patients who had been diagnosed with PTSD are helping us better understand the condition. There’s still a lot we can’t make sense of with PTSD, including why women seem to be more susceptible to it, and whether an impaired immune system plays a part.
The brain of the matter
The analysis was led by researchers from the Yale University, finding differences in gene expression patterns between patients with PTSD and healthy people in four regions of the prefrontal cortex (PFC). The PFC is associated with higher cognitive functions. These differences affected two types of cells in patients: interneurons, which inhibit neural activity, and microglia, immune system cells in the central nervous system, the researchers report.
“The findings suggest that together these changes might contribute to an impaired ability to respond to traumatic stress,” said Matthew Girgenti, a research scientist in the Yale Department of Psychiatry and lead author of the study.
Some 8% of the world’s population has been diagnosed with PTSD at one point or another, the authors explain. Among those who have experienced severe stress such as combat, natural disasters, assault, roughly 35% will show symptoms of PTSD. These include intrusive, distressing memories of the traumatic event, hyperarousal upon exposure to stimuli related to the traumatic event, or avoidance of others.
Most of the types of cells heavily impacted by PTSD were the same in men as well as women. The genders however differed in where exactly in the brain affected genes were being expressed. This may be the root of why women are almost twice as likely to develop PTSD and other anxiety disorders as men, and why their symptoms tend to be more severe, the authors explain.
Although almost half of the patients studied by the team were also diagnosed with some form of depression, gene expression patterns in their brains were only loosely tied with depression. They were much more closely linked biologically with schizophrenia and bipolar disorder
“This is a new beginning for the PTSD field,” noted John Krystal, a Professor at Yale and co-senior author of the paper. “We need new treatments for PTSD, and studies like this will provide the scientific foundation for a new generation of medication development efforts.”
The paper “Transcriptomic organization of the human brain in post-traumatic stress disorder” has been published in the journal Nature Neuroscience.
New research from the Centre for Addiction and Mental Health (CAMH) and the Canadian Institutes of Health Research (CIHR) may lead to the first clinical diagnostic tool for post-traumatic stress disorder (PTSD) and novel, reliable treatments.
PTSD is a debilitating mental health condition that can be triggered by either experiencing or witnessing extreme trauma. However, there are no clinical diagnostic tools for PTSD today, and treatment options are limited and of limited efficacy.
A new study into the physiological roots of PTSD and preventive measures against it could set that right, however. The authors report identifying a protein complex that’s elevated in the bodies of PTSD patients. The team developed a peptide compound that targets and disrupts this protein, which has proven effective in preventing the formation or recall of traumatic memories in early tests in mice.
“The discovery of the Glucocorticoid Receptor-FKBP51 protein complex provides a new understanding of molecular mechanisms underlying PTSD,” said Dr. Fang Liu, the study’s corresponding author. “We believe this protein complex normally increases after severe stress, but in most cases, levels soon go back to baseline levels.”
“However, in those who develop PTSD, the protein complex remains persistently elevated, and so this could be a blood-based biomarker for PTSD as well as being a target for pharmacological treatment.”
Back in 1915, English psychologist Charles Myers coined the term “shell shock” to describe the state of soldiers who were involuntarily shivering, crying, fearful, and experienced constant intrusions of distressing memories following their service in the hellscapes of World War One. “Shell shock” isn’t in current psychiatric use any longer as it has been rolled into the wider-ranging concept of PTSD. However, it can be seen as its intellectual forerunner.
We now know that such symptoms aren’t limited to army personnel. Victims of violent or sexual assault also often develop PTSD, as do survivors of non-assault based trauma (such as natural disasters), albeit less often.
PTSD is characterized by persistent and intrusive memories or nightmares of the traumatic event, heightened levels of anxiety and vigilance, general emotional unresponsiveness, and persistent avoidance of stimuli related to the trauma. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) lists 17 different symptoms of PTSD, and requires at least one (of the five) re-experiencing symptoms, at least three (of seven) avoidance symptoms, and at least two (of five) arousal symptoms to be present for one month for a diagnosis to be made.
It’s still a very current problem. The team examined statistics from 24 countries and found that Canada currently has the highest prevalence of PTSD among the lot. Around 9.2% of Canadians will develop PTSD during their lifetimes, they explain. A 2017 study estimated that around 6.8% of Americans will develop PTSD during their lifetime.
The authors of the new paper report that individuals with PTSD have heightened levels of a complex protein formed from the glucocorticoid receptor (GR) and the FKBP51 binding protein compared to healthy controls, people who were exposed to trauma without developing PTSD, and patients with major depressive disorders. Fear-conditioned mice also showed heightened levels of this protein complex, they add. These findings strongly suggest that the complex is a mediator for the disorder.
In order to validate their findings, the team designed the peptide TAT-GRpep (think of peptides as being chunks of protein) that binds to and disrupts the function of the GR-FKBP51 complex. TAT-GRpep works by binding to the GR, effectively taking up the spot that the protein complex needs to bind to in order to elicit a response in the body. They tested this peptide on lab mice and report that it was “able to decrease GR-FKBP51 complex levels in both blood and brain tissue from mice,” suggesting that it could also prove effective in humans.
“Because our interfering peptide can block the consolidation of fear memories, we propose that it or a therapeutic analog could be given to patients exposed to severe trauma, as a prophylaxis against the future emergence of PTSD,” the paper reads. “The protein complex could also be a treatment target for established PTSD symptoms and as a biochemical diagnostic marker for PTSD.”
“Any of these advances would significantly improve on current clinical approaches to this important brain disorder.”
Dr. Liu and her team plan to further test and refine the peptide before conducting human clinical trials.
The paper “The glucocorticoid receptor–FKBP51 complex contributes to fear conditioning and posttraumatic stress disorder” has been published in the Journal of Clinical Investigation.
A survey of more than 24,000 Canadians found that for those suffering from post-traumatic stress disorder (PTSD), medicating with cannabis reduced the likelihood of experiencing severe depression and suicidal thoughts.
As of 2018, cannabis is legal both recreationally and medically in Canada. This has made the drug more readily available to the general population, but there is still much we don’t know about its effects on mental health.
“We know that with limited treatment options for PTSD, many patients have taken to medicating with cannabis to alleviate their symptoms,” says Stephanie Lake, the lead author of the study and a researcher at the University of British Columbia’s faculty of medicine’s school of population and public health. “However, this is the first time that results from a nationally representative survey have shown the potential benefits of treating the disorder with cannabis.”
Lake and colleagues analyzed data from Statistics Canada’s 2012 Canadian Community Health Survey – Mental Health (CCHS-MH), which covers Canadians aged 15 and older. The survey, which involved 24,089 respondents, included 420 cases (no pun intended) of clinically diagnosed PTSD. Among this group, 106 reported using cannabis during the past year (28.2%). Only 11.2% of the respondents who didn’t have PTSD used cannabis in the past year.
The results are pretty shocking. They suggest that PTSD patients who did not use cannabis were nearly seven times more likely to experience a recent major depressive episode and 4.7 times more likely to experience suicidal ideation compared to cannabis non-users without PTSD. Meanwhile, cannabis-using PTSD patients did not experience a recent depressive episode or suicide ideation.
Canada is thought to have one of the highest prevalence rates of PTSD in the world, affecting an estimated 9.2% of the population.
“We’re only just beginning to understand what the therapeutic potential of cannabis may be for a variety of health conditions,” says senior author Dr. M-J Milloy, Canopy Growth Professor of Cannabis Science at UBC. “These findings are promising, and merit further study in order to fully understand the benefits of cannabis for people living with PTSD.”
That being said, you should not medicate with cannabis on your own. Talk to your doctor so you can come up with the right therapeutic solution that is specially tailored to your particular condition.
New research at Western University shows that animals can suffer post-traumatic stress disorder-like symptoms following exposure to predators.
Black-capped chickadee. Image via Skitterphoto.
Fear, especially strong fear such as that generated by life-threatening events, can cause significant and long-lasting changes in the circuitry of our brains. These neural changes lead to a host of shifts in behavior that we collectively refer to as post-traumatic stress disorder (PTSD).
Wild animals also experience these same changes in traumatic situations, new research shows. Fear of predators can lead to enduring neural changes that induce fearful behavior, comparable to effects seen in human PTSD patients.
“These results have important implications for biomedical researchers, mental health clinicians, and ecologists,” explains Liana Zanette, a biology professor in Western’s Faculty of Science and lead author of the paper.
“Our findings support both the notion that PTSD is not unnatural, and that long-lasting effects of predator-induced fear with likely effects on fecundity and survival, are the norm in nature.”
The team worked with wild-caught black-capped chickadees at Western’s Advanced Facility for Avian Research (AFAR). The birds were individually exposed to audio recordings of either predators or non-predator species for two days. Afterward, all birds were allowed to flock together in outdoor conditions for a week, during which they were not exposed to any further audio recordings.
They gauged ‘enduringly fearful behavior’ after this week-long period by measuring each individual’s reaction to hearing a chickadee alarm call distinct from those they were exposed to seven days previously. The team estimated each bird’s levels of fearfulness by measuring how long they remained ‘vigilant and immobile’ (i.e., ‘freezing’) upon first hearing the alarm calls. They used freezing as a proxy as it is an anti-predator behavior demonstrated in almost every type of animal, they explain.
“To assess effects on behaviour, individuals were again housed solitarily in acoustic isolation chambers, and all were exposed for 15 minutes to playbacks of conspecific alarm calls, a signal which, like hearing predator vocalizations, alerts the hearer to a predator danger,” the paper explains.
The long-term effects of exposure on the brain were assessed by measuring ∆FosB protein levels in the amygdala and hippocampus, two areas of the brain involved in PTSD in humans. The amygdala is responsible for fear processing and the acquisition and expression of fear memories, the team explains, whereas the hippocampus is involved in memory formation. ∆FosB is a transcription factor, meaning it can turn other genes on or off. It is “unusually stable” for a transcription factor (i.e. has long-lasting effects) and, among other things, is known to promote resistance to the consequences of chronic stress.
Zanette’s team is the first to show that the effects of predator exposure on the neural pathways that govern fear in animals can persist far beyond the initial ‘fight or flight’ response. They showed that this response remains measurable over one week later even for animals that have been allowed a peaceful, quality life after exposure.
They explain that retaining a powerful and enduring memory of a life-threatening predator encounter might seem crippling, but it’s actually evolutionarily-rewarding if it helps the individual avoid such events in the future. The team says their findings support the view that PTSD is the cost of inheriting an evolutionarily primitive mechanism that prioritizes survival over the quality of life.
The results suggest predator exposure could impair the behavior of prey species much more, and for longer than previously assumed. They also tie in well with past research in which Zanette and her collaborators show that scared parents are less able to care for their young.
The paper “Predator-induced fear causes PTSD-like changes in the brains and behaviour of wild animals” has been published in the journal Scientific Reports.
It’s common for people who have lived through traumatic experiences to report trouble sleeping and constant feelings of anxiety. According to new research, people with post-traumatic stress disorder (PTSD) might benefit from high-intensity resistance training — in other words, weightlifting or strength training — which was found to reduce anxiety and improve sleep quality.
James Whitworth is a postdoc researcher at the Boston VA Healthcare System and Boston University School of Medicine. He is also a veteran who fought in Iraq. While stationed there, the researcher remembers how he and other soldiers would find it easier to deal with the psychological stress of warfare after exercising. Now, many years later, Whitworth has used this experience as a starting point for a new study that investigated the relationship between resistance training and changes in PTSD symptoms.
Whitworth and colleagues recruited 22 participants with PTSD who were split into two groups: a resistance training group and a control group. The resistance training group performed three, 30-minute high-intensity training sessions per week over the course of three weeks. Meanwhile, the control group completed three, 30-minute study sessions focusing on various topics unrelated to exercise or PTSD per week for three weeks.
Both types of interventions reduced PTSD symptoms for the participants. However, those in the resistance-training group showed significantly better improvements in sleep quality and reductions in anxiety symptoms compared to the control group.
This was not the first study that found exercising can improve PTSD symptoms. For instance, Mathew Fetzner and Gordon Asmundson at the University of Regina found that two weeks of stationary biking can be helpful in reducing PTSD symptoms and improving mood. Researchers at Loughborough University have reviewed multiple studies that looked at the impact of exercising and physical activity on combat veterans diagnosed with PTSD, finding that physical activity (i.e. surfing) enhances well-being in veterans by reducing symptoms and improving coping strategies.
In the future, the researchers would like to see their study replicated for a larger sample size and in other populations. One important question that they would like to see answered is how exactly exercise affects the psychological health of PTSD patients.
“The findings of this study suggest that three weeks of high intensity resistance training can improve aspects of sleep and reduce anxiety in individuals who screen positive for PTSD. The results further support the safety, feasibility, and acceptability of resistance training for this population. These results are preliminary, and should be further verified by larger adequately powered trials,” the authors concluded in the journal Mental Health and Physical Activity.
Elements of the 3rd Stryker brigade on patrol in Iraq. Credit: Wikimedia Commons.
Researchers designed an artificial intelligence tool that can diagnose post-traumatic stress disorder (PTSD) in veterans simply by analyzing their voices. The AI was able to distinguish between PTSD and non-PTSD voices with 89% accuracy.
“Our findings suggest that speech-based characteristics can be used to diagnose this disease, and with further refinement and validation, may be employed in the clinic in the near future,” said senior study author Charles R. Marmar, from the Department of Psychiatry at NYU School of Medicine, in a statement.
PTSD diagnosis is typically performed in a clinical setting by a doctor who conducts a face-to-face interview with the patient, or through a self-reported assessment. The human element makes both methods prone to bias, which is why researchers have been trying to find a more objective, measurable way to diagnose the condition by reading physical cues.
When we speak, we not only convey information but also emotional content through the quality of the voice. Experienced doctors know that a person who speaks in a monotone, lifeless voice and has impaired speech may be suffering from PTSD. According to one theory, the condition may impact brain circuits that process emotion and muscles, thereby affecting a person’s voice.
With the help from engineers at SRI International, the institute behind the world-famous voice assistant Siri, researchers designed a new AI that scans a person’s voice for signs of PTSD. The AI is based on a machine learning technique called random forests which enables a computer to classify objects based on examples. As the machine is trained with more data, it can more accurately perform decision-making.
For their study, the researchers first recorded interviews with 53 Iraq and Afghanistan veterans who came back home with PTSD after their service, as well as with 78 veterans who didn’t have PTSD. These voice recordings were then fed into the machine, producing 40,526 speech-based features which the AI could comb for patterns.
In the future, the researchers hope that their software might be integrated into diagnostic systems, perhaps even into a simple smartphone app that people can use to cheaply and remotely assess their PTSD score and then seek professional help.
New research is looking into the cells that block, or allow, frightening memories to pop up into our minds.
Image credits Henry Gray / Anatomy of the Human Body (1918) via Wikimedia.
Researchers at The University of Texas at Austin have identified the group of neurons that handle scary, recurrent memories. The findings could help us better tailor therapy for the treatment of anxiety, phobias, and post-traumatic stress disorder (PTSD).
“There is frequently a relapse of the original fear, but we knew very little about the mechanisms,” said Michael Drew, associate professor of neuroscience and the senior author of the study. “These kinds of studies can help us understand the potential cause of disorders, like anxiety and PTSD, and they can also help us understand potential treatments.”
Drew and his team worked with a group of lab mice, which they trained to associate a distinctive box with fear. Each mouse was repeatedly placed inside the box and given a harmless electrical shock until they started associating this box with feelings of pain. Needless to say, this rendered the mice quite scared of having to go inside said box.
The end result was that the mice would display fear when inside the box. In the second step of the experiment, the same mice were placed inside the box without receiving the shock. They kept displaying fear initially, the team reports. However, as exposure to the box continued without the shock being administered, the association weakened. Eventually, the mice stopped showing signs of fear. The authors explain that repeated exposure without the painful shock created extinction memories in the mice’s minds in place of the earlier, painful and fear-inducing memories.
This is a glimpse of how our brain stores and handles conditioned responses, a process which has been heavily studied and documented ever since Pavlov and his drooling dogs. However, there are still things we don’t understand. Among these, and something the team wanted to understand, is how and why memories or responses we thought were behind us can still pop up in our minds, triggering spontaneous recovery (think of it as a form of traumatic-memory relapse).
In order to find out, they artificially activated fear responses and suppressed extinction trace memories through the use of optogenetics (a technique that uses light to turn neurons on or off).
“Artificially suppressing these so-called extinction neurons causes fear to relapse, whereas stimulating them prevents fear relapse,” Drew said. “These experiments reveal potential avenues for suppressing maladaptive fear and preventing relapse.”
Drew’s team was surprised to find that the brain cells responsible for suppressing or allowing fear memories to surface are nestled in the hippocampus. The traditional view is that fear is born of the amygdala, the primitive ‘lizard’ level of our brains. The hippocampus is actually heavily involved in aspects of memory, but generally in the process of linking memory with spatial navigation. The team’s hypothesis is that the hippocampus’ job is to provide spatial context for memories, i.e. where something happened or how you got there.
Their findings could, therefore, explain why exposure therapy — one of the most common treatment avenues for fear-based disorders — sometimes simply stops working. Exposure therapy works by creating safe (extinction) memories to override the initial, traumatic one. For example, someone who’s scared of spiders after being bitten by one can undertake exposure therapy by letting a harmless spider crawl on his hand.
While the approach is sound, the team reports, it hinges on our hippocampus‘ willingness to play ball.
“Extinction does not erase the original fear memory but instead creates a new memory that inhibits or competes with the original fear,” Drew said.
“Our paper demonstrates that the hippocampus generates memory traces of both fear and extinction, and competition between these hippocampal traces determines whether fear is expressed or suppressed.”
The findings suggest we should revisit how we time exposure therapy, and how frequently patients should undergo exposure sessions, according to the authors.
Paper DOI http://dx.doi.org/10.1038/s41593-019-0361-z
Stacking blocks may help soothe those struggling with post-traumatic stress disorder (PTSD), say Swedish researchers.
Image via Pexels.
That oldie but goldie of games, Tetris, could help patients with PTSD manage one of the disorder’s central symptoms: traumatic flashbacks. The findings come from a preliminary study carried out by researchers at the LWL University Hospital Bochum and Karolinska Institutet (both in Sweden), who hope to develop an avenue of supportive treatment for patients who cannot access conventional help.
Blocking out the memory
“PTSD can be treated well using the therapies available,” says Henrik Kessler, a senior physician and trauma therapist at Bochum, who led the research effort.
“However, there are many more patients than therapy places. That’s why the researchers are looking for methods outside conventional treatments that can relieve the symptoms.”
The study was borne from previous research carried out by Emily Holmes and her team at the Karolinska Institutet. They found that Tetris can be used to suppress flashbacks caused by horror films if played shortly after viewing the movie. The current study builds on those findings — the researchers wanted to determine if the same mechanism can be used to suppress much older stressful memories, potentially dating back several years.
Kessler’s team worked with 20 patients with complex PTSD, all of whom were hospitalized at the Department of Psychosomatic Medicine and Psychotherapy for six to eight weeks for regular therapy. Each patient was asked to undergo a special intervention — in addition to their usual individual and group therapy sessions — as part of the study. Every participant wrote down one stressful memory on a sheet of paper. This step was needed as a ‘reminder’, to bring a specific event to the forefront of the patient’s attention. They then tore up the sheet without talking about the content and played Tetris on a tablet for about 25 minutes.
Each patient was also asked to record several different flashbacks — for example, violent experiences in different situations — over the course of the trial. The team writes that they focused the Tetris treatment on a single specific flashback during every intervention (which were carried out week by week). Some of the flashbacks listed by the patients were never addressed, the team adds — these were used as controls.
The frequency of the targeted flashbacks decreased in the weeks following the interventions. Various flashback contents were targeted one after the other during the trial, and their incidence decreased over time. The number of untargeted (control) flashbacks remained relatively constant, the team adds, suggesting the interventions themselves had worked in their intended role. Overall, the team reports, flashbacks for the targeted situations fell by 64% on average. Flashbacks for untargeted situations only fell by 11%. The intervention had a significant effect for 16 of the 20 patients tested.
When patients relive a stressful memory in detail, it engages areas in the brain responsible for visuospatial processing. Kessler’s team thinks that playing Tetris activates roughly (or comparable) areas in the brain, which creates interference. When we relive a memory, it temporarily becomes unstable — our brain has to take it out of the archives and flip the pages, so to speak. Since the brain has limited resources at its disposal, if this interference happens as the memory is ‘in use’, it can weaken by the time it is stored again, or become weaker as it is being stored. This is the mechanism that the team suspects led to the decline in flashbacks.
“In our study, the intervention was supervised by a team member, but he did not play an active role and did not read the written traumatic memories,” explains Kessler. “Our hope is that we will be able to derive a treatment that people could perform on their own to help them cope, even if there are no places available for therapy.”
“However, the intervention cannot replace complex trauma therapy, but can only alleviate a central symptom, flashbacks.”
The research is still in its very early stages, the authors explain. However, Kessler’s team is already working on a follow-up study using control conditions and a significantly larger number of patients. In addition, they are also investigating the exact mechanisms behind the effect in healthy people in experimental studies.
The paper “Reducing intrusive memories of trauma using a visuospatial interference intervention with inpatients with posttraumatic stress disorder (PTSD)” has been published in the Journal of Consulting and Clinical Psychology.
MDMA, also known as ecstasy, is known to make users more empathetic and willing to connect with other people. According to a new study, this may partly be explained by the drug’s ability to boost cooperative behavior.These findings suggest that MDMA causes changes in activity in brain regions linked to social processing, making it relevant for treating psychiatric conditions such as post-traumatic stress disorder (PTSD).
Credit: Wikimedia Commons.
Researchers at King’s College London gave 20 healthy adult men either a typical recreational dose of MDMA or a placebo. The participants then had to complete several tasks while in an MRI machine that scanned their brain activity, including the Prisoner’s Dilemma.
The Prisoner’s Dilemma is one of the most famous and most discussed case studies in both economics and psychology introductory classes. In this scenario, two prisoners are each isolated from one another and have to make one of two choices: either they turn the other in (sabotage) or remain silent (cooperate). If both players cooperate, they each receive some points (both win) but if one player chooses to compete, they receive all the points while the other player gets nothing (one wins, the other loses).
In this experiment, the participants thought they were playing the Prisoner’s Dilemma game with other real people. In fact, the other player was a pre-programmed computer response which would behave either in a trustworthy or untrustworthy manner throughout the various rounds of the game.
While under the influence of MDMA, participants were more inclined to cooperate than those who just received a placebo — but only when interacting with trustworthy players.
“We asked people what they thought of their opponent and, surprisingly, MDMA did not alter how trustworthy they thought the other players were. Untrustworthy players were rated as low on the scale, whether on MDMA or placebo, and trustworthy players were given equally high ratings,” senior author Professor Mitul Mehta said in a statement.
“Importantly, MDMA did not cause participants to cooperate with untrustworthy players any more than normal. In other words, MDMA did not make participants naively trusting of others.”
The MRI scans showed that while high on MDMA, participants had increased activity in the superior temporal cortex and mid-cingulate cortex, which are areas known to be important in understanding the thoughts, beliefs, and intentions of other people. More importantly, MDMA increased activity in the right anterior insular when the participants played the game with trustworthy players, and decreased activity in the brain region when processing the behavior of untrustworthy players. This shows that MDMA impacts the way we process other people’s behavior, rather than altering the decision-making process itself, the authors noted in The Journal of Neuroscience.
Some psychiatric conditions are underlied by improper brain activity connected to social behavior. Understanding how MDMA affects social interactions is important in the context of psychotherapy, where the drug could become a valuable tool in treating patients.
The 2016 Presidential election, which saw Donald Trump rise to power, was marked by some of the most divisive campaigns in American history. So much so that for some young adults, the experience was genuinely traumatic. According to psychologists, one in four young adults experienced symptoms similar to those seen in post-traumatic stress disorder.
Melissa Hagan, an assistant professor of psychology at San Francisco State University, noticed that in the months following the election, her students appeared significantly affected. Surveys conducted at the time also confirmed some part of the population experienced psychological stress in the aftermath of the election.
Looking to put a finger on how much stress the 2016 election caused, Hagan and colleagues, enlisted 769 students who were taking a psychology course at Arizona State University. The participants included a variety of racial and ethnic backgrounds, as well as religious and political identities.
Using a standard psychological assessment tool called the Impact of Event Scale (IES), researchers surveyed how many of the students were impacted by the election in such a way that it might lead to diagnosable PTSD.
According to the results, 25% of the students crossed the PTSD threshold. Another frightening result was that the average score of students was comparable to those obtained by witnesses of a mass shooting seven months after the event.
“What we were interested in seeing was, did the election for some people constitute a traumatic experience? And we found that it did for 25 percent of young adults,” Hagan said in a statement.
Researchers also determined that 37.2% of students were completely dissatisfied with the election results and 18.5% were completely satisfied — everyone else was in the middle. When the researchers gauged the extent to which the students were upset by the results, they found that 39% of students were extremely upset, while 28.5% reported not feeling upset at all. About 24.2% of the students said their relationships were impacted negatively by the election, 10.4% said there was some negative impact, and 65% experienced no impact at all.
Some students were more affected than others. Black and nonwhite Hispanic participants scored higher on the PTSD assessment than their white counterparts. Females scored nearly 45% higher than males, and Democrats scored more than two and a half times higher than Republicans, the authors reported in theJournal of American College Health.
It’s not clear whether the traumatic effects of the 2016 elections will carry on over the long-term, as the psychological assessment of the students only happened once. The high prevalence of PTSD symptoms, however, should warrant school mental health staff to be more mindful of the political environment which their students are experiencing, apart from the usual stressors. And given the level of stress measured by the researchers, it wouldn’t be all that surprising to see some of the negative effects on people’s mental health last for years.
As to what made this election particularly traumatic, the shock of Donald Trump’s win and the hate-centered divisive narrative seem to have played important roles.
“There was a lot of discourse around race, identity and what makes a valuable American. I think that really heightened stress for a lot of people,” said Hagan.
Even when you get rid of cancer the mental effects can still linger for a long time. A new study found that one-fifth of all patients with cancer experience post-traumatic stress disorder (PTSD) several months after diagnosis. Many patients continue to suffer from PTSD for years and years.
Image credits: Lily Lvnatikk.
Although PTSD is a condition typically thought of as emerging as a result of an accident, war, or natural disaster, it can also be triggered by a different type of event: disease. Due to its grieving nature, cancer, in particular, seems capable of triggering PTSD. Because this aspect is understudied, Caryn Mei Hsien Chan, PhD, of the National University of Malaysia, and her colleagues inspected 469 adults with various cancer types. They surveyed the patients within one month after diagnosis, six months later, and again after four years.
They found a PTSD incidence of 21.7% at 6-months follow-up, with rates dropping to 6.1% at 4-years follow-up. While the rates did go down significantly, they were still significant even after four years, comparable to war-induced PTSD, though arguably not as intense; for comparison, as many as 10% of Gulf War (Desert Storm) veterans and 11% of veterans of the war in Afghanistan suffer from PTSD.
“Many cancer patients believe they need to adopt a ‘warrior mentality’, and remain positive and optimistic from diagnosis through treatment to stand a better chance of beating their cancer. To these patients, seeking help for the emotional issues they face is akin to admitting weakness,” said Dr. Chan. “There needs to be greater awareness that there is nothing wrong with getting help to manage the emotional upheaval-particularly depression, anxiety, and PTSD-post-cancer.”
The main concern for cancer survivors is that the diseases will return, but other factors are also at play. Other aspects of the cancer experience that might trigger PTSD include:
Being diagnosed with the disease;
Diagnosis of an advanced cancer;
Painful tests and treatments;
Pain from the cancer itself or other physical issues;
Long hospital stays or treatments.
In addition to reducing the quality of life of patients, there are also concerns that the stress can lead to delays in seeking help for new symptoms or even refusal of treatment for unrelated conditions.
Researchers also say that their work can help better design counseling strategies for patients. For instance, patients with breast cancer were 3.7 times less likely to develop PTSD at six months than patients with other cancers, but not at four years. This likely happened because patients had access to a dedicated support program focusing on breast cancer. Focusing resources for such programs on patients more likely to suffer from PTSD and depression
“We need psychological evaluation and support services for patients with cancer at an initial stage and at continued follows-up because psychological well-being and mental health-and by extension, quality of life-are just as important as physical health,” said Dr. Chan.
According to official figures, at least 7 or 8 in a hundred Americans will struggle with the disorder at some point in their lives. Some will never get rid of it. Some will be driven to suicide. It’s a complex and far reaching problem that disproportionately affects people in the military, for reasons that are easy to understand. Well, this new avenue for treatment gives unexpected hope to these millions of people.
Drugs versus disorders
It’s not the first time psychedelic drugs have been suggested as therapy for PTSD. It’s actually something that researchers have recommended for a long time. In 2012, MDMA has been shown to be effective in treating PTSD, though in a small trial. That same year, researchers also showed that the drug was safe for consumption in a regulated setting. Earlier this year, the findings were echoed over a larger spectrum of drugs, including LSD — though again, it was a small trial. This is one of the biggest hurdles when it comes to studying the potential of such substances: it’s virtually impossible to set up a large-scale trial. Well, that will change now, as a Phase 3 trial has been approved for the first time. Phase 3 trials are randomized controlled multicenter trials on large patient groups, with at least 300 participants.
“For the first time ever, psychedelic-assisted psychotherapy will be evaluated in Phase 3 trials for possible prescription use, with MDMA-assisted psychotherapy for PTSD leading the way,” said Rick Doblin, Founder and Executive Director of MAPS.
For anyone who ever took MDMA, it’s probably easy to understand why: for starters, it makes you feel very good. But there’s much more to it than that. The drug fills the user’s brain with the neurotransmitters that not only make them feel good, but also help them deal with painful memories. Basically, every time you recall a memory, you’re firing up some neurons. The neurons have a tendency to use the same connections time and time again — basically, walking on the beaten path — which means that a fearful memory will likely remain fearful. But new connections can also be made, and therefore the memory can be revised and dealt with. This is where MDMA helps. Simply put, it can use some of that feel-good to make fearful memories less fearful. Of course, taking the drug in a safe, controlled environment is a completely different experience than taking it at a party, and that’s what scientists are recommending here.
Not perfect, but promising
MAPS has been conducting MDMA trials since 1986, hoping to demonstrate its value to authorities. In one study, 67 percent of PTSD patients had no signs of the disorder after three MDMA therapy sessions. Just 23 percent of patients who didn’t take MDMA reported similar results. Another study tracked the long-term development of 16 patients who were unresponsive to any kind of treatment. Two of them had relapses — but the rest were cured following MDMA sessions.
In that sense, this isn’t a breakthrough in science, but rather in acceptance, both legal and social.
“This is not a big scientific step,” David Nutt, a neuropsychopharmacologist at Imperial College London, explained to Science. “It’s been obvious for 40 years that these drugs are medicines. But it’s a huge step in acceptance.”
Of course, this isn’t going to magically make PTSD disappear. It’s probably not going to work for everyone. Few treatments do. Some psychologists argue that giving people ecstasy isn’t going to help anyone, or that the treatment itself is unnecessary. But previous trials show that the treatment is effective, at least most of the time. It could drastically improve the lives of millions and it could save a lot of lives. If that’s not worth fighting against prejudice, then I don’t know what is.
The first Phase 3 trial (MAPP1), “A Randomized, Double-Blind, Placebo-Controlled, Multi-Site Phase 3 Study of the Efficacy and Safety of Manualized MDMA-Assisted Psychotherapy for the Treatment of Severe Posttraumatic Stress Disorder,” will begin enrolling subjects in Spring 2018,
A study conducted by researchers from Leicester University shows how an entire generation of children in Gaza is traumatized by PTSD and anxiety.
“Why is it always the innocents who suffer most, when you high lords play your game of thrones?” – Varys, A Game of Thrones
War is almost never about soldiers fighting soldiers. Usually, war is about soldiers fighting soldiers and civilians; and nowadays, to be honest, it’s more about missiles and drones versus civilians. Imagine how it would be like growing up in such an area, where every day is a risk, where people you know are constantly threatened and killed, and where you don’t have the safety of a tomorrow. A new study has quantified the psychological effects of long term war exposure on adolescents, and the results are grim.
Professor Panos Vostanis from the University of Leicester’s Greenwood Institute of Child Health, Professor Abdelaziz Thabet from Al-Quds University and Omar EL-Buhaisi from the University of Leicester investigated the traumatic effects endured by Palestinian adolescents exposed to war in Gaza in relation to post-traumatic stress disorder (PTSD), anxiety and coping strategies. They studied 358 adolescents aged 15 to 18 years; most of them have been exposed several times to mutilated bodies on TV, were exposed to heavy artillery shelling, saw evidence of shelling and heard sonic sounds from jetfighters. Here are some of the figure the subjects reported:
90% of them have seen mutilated bodies on TV
88.5% have heard shelling of an area by artillery
86.6% have seen shelling evidence on the ground
67% have witnessed people being killed by rockets
60.6% have had a close relative killed by rockets
46.1% have been directly threatened by shooting
29.9% have directly witnessed the killing of a friend
27.7% have witnessed their own home be bombarded
26% have been beaten by the military
22.9% have been arrested
21.8% were physically injured by a bomb in their home
Take a look at these figures, and remember – these are children we’re talking about! It’s people under 18 years old, living in a constant state of fear and real threat. They see their friends killed, their houses bombarded, and are threatened by a military conflict; under these conditions, I find it actually a bit surprising that the rates for anxiety is “only” 33% for girls and 26% for boys. Overall, the study showed that 29.8% of participants met the full criteria for PTSD.
But perhaps the long term implications are even more severe. We’re talking about a generation of children who will grow up, and likely harbor feelings of extreme anger, probably prolonging the conflict even more. The point of this study is not to show that Israelis are the aggressors or that the Palestinians are the victims, it’s to show that in this war, the ones who suffer the most are civilians – and especially children.
Scientific Reference: Abdelaziz Thabet, Omar EL-Buhaisi, Panos Vostanis. Trauma, PTSD, Anxiety and Coping Strategies among Palestinians Adolescents Exposed to War in Gaza.The Arab Journal of Psychiatry (2014) Vol. 25 No. 1 Page (71–82)(dio: 10.12816/0004117)