Abstract
Many biological systems are altered in association with posttraumatic stress disorder
(PTSD) and resilience. However, there are only few approved pharmacological treatments
for PTSD, and no approved medications to enhance resilience. This article provides
a critical review of select neurobiological findings in PTSD and resilience, and also
of pharmacologic approaches that have emerged from this work. The medications summarized
involve engagement with targets in the adrenergic, hypothalamic-pituitary-adrenal
axis, and neuropeptide Y systems. Other highlighted approaches involve the use of
ketamine and 3,4-methylenedioxymethamphetamine–assisted psychotherapy, which recently
surfaced as promising strategies for PTSD, though the neurobiological mechanisms underlying
their actions, including for promoting resilience, are not yet fully understood. The
former approaches fall within the broad concept of “rational pharmacotherapy,” in
that they attempt to directly target dysregulated systems known to be associated with
posttraumatic symptoms. To the extent that use of ketamine and 3,4-methylenedioxymethamphetamine
promotes symptom improvement and resilience in PTSD, this provides an opportunity
for reverse translation and identification of relevant targets and mechanisms of action
through careful study of biological changes resulting from these interventions. Promoting
resilience in trauma-exposed individuals may involve more than pharmacologically manipulating
dysregulated molecules and pathways associated with developing and sustaining PTSD
symptom severity, but also producing a substantial change in mental state that increases
the ability to engage with traumatic material in psychotherapy. Neurobiological examination
in the context of treatment studies may yield novel targets and promote a greater
understanding of mechanisms of recovery from trauma.
Keywords
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Article Info
Publication History
Published online: July 24, 2019
Accepted:
July 16,
2019
Received in revised form:
July 8,
2019
Received:
March 29,
2019
Identification
Copyright
Published by Elsevier Inc on behalf of Society of Biological Psychiatry.
