Can You Stop PTSD Before It Starts?
Farha Motiwala, M.D.
Michele Morais, M.D.
Saurabh Bhardwaj, M.D.
Nwakile Ojike, M.D.
Steven Lippmann, M.D.
University of Louisville School of Medicine
Department of Psychiatry and Behavioral Sciences
Posttraumatic stress disorder (PTSD) has become a prominent psychiatric concern in recent years. PTSD can be induced by an emotionally traumatic incident. (1) Resistant to many conventional therapies, new modalities of intervention are being sought.(2) Strategies for the prevention of PTSD after a precipitating event are called for and one new, potential modality includes glucocorticoid administration.
The neurotransmitter norepinephrine is produced after a stressful experience; it promotes understanding the dangerousness of the recent situation. (3,4) Thereafter, cortisol secretion facilitates an ability to cope by diminishing reemergence of fearful memories. (3,4) In PTSD, there is a dysfunction of the hypothalamic pituitary axis, with decreased levels of cortisol. Glucocorticoid receptors become hyper responsive, resulting in physiologically increased negative feedback, with a positive result on dexamethasone suppression testing. (1) That manifests clinically as PTSD. With low cortisol levels, PTSD patients are less able to effectively suppress traumatic memories. (3,4)
Oral hydrocortisone at a 20 mg dose can suppress startle responses in normal subjects and in patients with PTSD. (5) If prescribed immediately after an acutely upsetting incident, administering hydrocortisone at >35mg dosages has evidenced a reduction in the retrieval of troublesome memories in potential cases of PTSD. (4) Thus, prescribing 35 mg (or more) of hydrocortisone may inhibit the development of PTSD, if taken shortly following a severely traumatic event. Clinicians may consider this still experimental therapy as an option to prevent PTSD before it develops. The yet unapproved status of hydrocortisone pharmacotherapy for preventing PTSD must be made clear to the patient before prescribing it.
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(3) Blundell J, Blaiss CA, Lagace DC, Eisch AJ, Powell CM. Block of glucocorticoid synthesis during re-activation inhibits extinction of an established fear memory. Neurobiology of Learning and Memory 2011;95(4):453-460
(4) Putman P, Roelofs K. Effects of single cortisol administrations on human affect reviewed: Coping with stress through adaptive regulation of automatic cognitive processing. Psychoneuroendocrinology 2011;36:439-448
(5) Miller MW, McKinney AE, Kanter FS, Korte KJ, Lovallo WR. Hydrocortisone suppression of the fear-potentiated startle response and posttraumatic stress disorder. Psychoneuroendocrinology 2011;36:970-980