Neuroendocrine biomarkers of prolonged exposure treatment response in military-related PTSD. (September 2020)

• Record Type: Journal Article
• Authors: Rauch, Sheila A.M.; Sripada, Rebecca; Burton, Mark; Michopoulos, Vasiliki; Kerley, Kimberly; Marx, Christine E.; Kilts, Jason D.; Naylor, Jennifer C.; Rothbaum, Barbara O.; McLean, Carmen P.; Smith, Alicia; Norrholm, Seth D.; Jovanovic, Tanja; Liberzon, Israel; Williamson, Douglas E.; Yarvis, COL Jeffrey S.; Dondanville, Katherine A.; Young-McCaughan, Stacey; Keane, Terence M.; Peterson, Alan L.
• Is Part Of: Psychoneuroendocrinology. Volume 119(2020)
• Publication Date: 2020-09
• Subjects: Posttraumatic stress disorder -- Cortisol -- Allopregnanolone -- Pregnanolone -- DHEA -- Treatment; Psychoneuroendocrinology -- Periodicals; Endocrinology -- Periodicals; Neurology -- Periodicals; Psychiatry -- Periodicals; Neuropsychoendocrinologie -- Périodiques; 616.8
• DOI: 10.1016/j.psyneuen.2020.104749
• Languages: English
• ISSNs: 0306-4530

Abstract

Highlights: Higher cortisol reactivity during script-driven imagery is associated more severe PTSD. Baseline allopregnanolone, pregnanolone and cortisol reactivity predict magnitude of PTSD reduction in treatment. Neuroendocrine biomarkers could be used to determine which patients are likely to respond to treatment. Abstract: Posttraumatic stress disorder (PTSD) is associated with dysregulation of the neuroendocrine system, including cortisol, allopregnanolone, and pregnanolone. Preliminary evidence from animal models suggests that baseline levels of these biomarkers may predict response to PTSD treatment. We report the change in biomarkers over the course of PTSD treatment. Biomarkers were sampled from individuals participating in (1) a randomized controlled trial comparing a web-version of Prolonged Exposure (Web-PE) therapy to in-person Present-Centered Therapy (PCT) and (2) from individuals participating in a nonrandomized effectiveness study testing PE delivered in-person as part of an intensive outpatient PTSD program. We found that higher cortisol reactivity during script-driven imagery was associated with higher baseline PTSD severity and that baseline allopregnanolone, pregnanolone, and cortisol reactivity were associated with degree of symptom change over the course of intensive outpatient treatment. These findings demonstrate that peripherally assessed biomarkers are associated with PTSD severity and likelihood of successful treatment outcome of PE delivered daily over two weeks. These assessments could be used to determine which patients are likely to respond to treatment and which patients require augmentation to increase the likelihood of optimal response to PTSD treatment.