Testing Treatments

How the disease impacts patients over time remains relatively unknown. Little has been done in the way of longitudinal imaging studies in PTSD patients. One study in 2003 showed patients treated with peroxetine — commonly used to treat depression and anxiety disorders — showed an increase in hippocampus size. Beyond that, little is known about how PTSD treatment counteracts the physical effects of the disease.

SFVAMC researchers are undertaking imaging studies on patients who have recovered from PTSD. Results have shown that people who have a past history of PTSD, but who currently do not suffer from it, have a hippocampus that looks totally normal.

“But we don’t know if, as their symptoms improve, their hippocampus expands in size or if a small hippocampus is a risk factor for PTSD,” Neylan said.

SFVAMC is moving toward a longitudinal study looking at different forms of treatment and imaging patients’ brains as they undergo the treatment process.

“Ultimately, we want to treat people and help them feel better,” Neylan said. “VA has two types of treatments for PTSD. One is prolonged exposure therapy, and the other is cognitive-processing therapy. The reality is that we are woefully lacking more comprehensive treatment studies on medications, psychotherapies, adjunctive treatments and alternative medicines. We really need a much better repertoire of treatments to offer veterans. That’s a glaring gap that we need to work on.”

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