The changes in the opioid system might account for what are called
the "negative" symptoms of PTSD: emotional numbness, apathy, and lack of
zest or interest in life. These negative symptoms often alternate with
more flamboyant ones such as nightmares or nervousness, or mix with them
in a confusing welter of ups and downs.
In a study by the Harvard Medical School and the VA Medical Center
in Manchester, New Hampshire, men with PTSD were shown a harrowing ambush
scene from the movie Platoon--twice. The first time, they were given a
placebo; the second time, they got naloxone, a drug which acts to block
the opioid system.
"We found that veterans with PTSD who watched the movie after
having taken the placebo showed a strong drop in their sensitivity to
rain while watching," says Roger Pitman, M.D., an associate professor of
psychiatry at Harvard Medical School.
Researchers consider such a drop in pain sensitivity to be a direct
clue to the workings of the veterans' opioid systems.
Their drop in pain sensitivity, says Dr. Pitman, was blocked by the
naloxone. This suggests that the combat stimulus did activate the opioid
system to release endorphins, which blunt pain. That may explain the
perplexing accounts of mortally wounded soldiers who have continued to
fight on, oblivious to the severity of their wounds: Under extreme
duress, the body secretes substances that dull the very sensation of
pain.
In PTSD, that response seems to continue, sensitizing the nerve
pathways regulating endorphins so that they continue to blunt pain--even
in reaction to mere images of battle.
This research is all directed toward one ultimate goal: developing
new, more effective treatments for PTSD. The preliminary findings have
prompted leading pharmaceutical firms to seek medications that will
restore a balance to the brain systems that have been altered by trauma.
For instance, medication that would block the action of CRF could
compensate for that compound's oversecretion. No such drug currently
exists.
While there is no medication yet that is specifically effective for
all of the brain changes underlying PTSD, some offer partial relief. One
is clonidine; another propranolol. Both have been useful for other
disorders where there is an excess of adrenaline. But no drugs relieve
all of the PTSD symptoms. And no one sees medication as the sole
answer.
"Drugs are an adjunct to psychotherapy," says Matthew Friedman,
M.D., executive director of the National Center for PTSD and a professor
of psychiatry and pharmacology at Dartmouth.
But, he adds, "many PTSD patients are so anxious they can't even
participate in therapy. Drugs that tone down their symptoms can make them
able. People feel less driven and anxious and can sleep better with fewer
nightmares," Dr. Friedman says. "But there are other problems such as
alienation, emotional numbness, guilt, and moral pain that only
psychotherapy can help solve."
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