Cohen Veterans Bioscience, Stanford University partner on PTSD
Despite many years of pioneering work characterizing the brains, behavior, and physiology of individuals with post-traumatic stress disorder (PTSD), the field of psychiatry lacks objective biological measures for understanding the many biological variations in people with the same clinical diagnosis of PTSD. This means that there are no reliable ways to determine who will benefit from which treatment. A new collaboration between Cohen Veterans Bioscience and Stanford University School of Medicine seeks to change this by studying clinical biomarkers as a way to help match patients to the best available treatment.
Amit Etkin, M.D., Ph.D., associate professor in the Department of Psychiatry and Behavioral Sciences at Stanford University and at the Palo Alto VA, and colleagues, with a grant from Cohen Veterans Bioscience, will look at 160 veterans who are currently receiving psychotherapythe first-line treatment for PTSDeither with prolonged exposure therapy (PE) or cognitive processing therapy (CPT) in the Mental Health Clinic at the Palo Alto VA and Albuquerque VA. Patients will be evaluated before treatment to measure a cognitive biomarker that predicts whether that individual will respond to PE or CPT and tracked for six months post-treatment to evaluate the marker's predictive value.
This new collaboration extends upon a treatment-predicting brain marker that Dr. Etkin discovered using functional MRI scans, which was found to be present in a portion of both veterans and civilians with PTSD. The next phase is to replicate this finding in veterans diagnosed with PTSD who are undergoing treatment, either with PE or CPT. The study will also include a control group of veterans without PTSD.
Functional MRI (fMRI) scans, which measure changes in blood flow that follow changes in brain activity, are hard to standardize for widespread clinical use. Therefore, this study also seeks to translate Dr. Etkin's earlier fMRI findings to a more widely-accessible form of brain scanning, which uses electroencephalography (EEG or "brain wave" recordings). If successful, these brain biomarkers will be the first of their kind for PTSD and have the potential to accelerate the pace of discovery of effective treatments for patients by uniting them with the best interventions more quickly.
Previous studies conducted by Dr. Etkin's lab have used non-invasive neuro-stimulation approaches, such as transcranial magnetic stimulation (TMS), to identify the brain regions involved in PTSD and other mental conditions, as well as response to treatment. By measuring activity of specific circuits in the brain, which controls behavior, TMS uncovers the cause of a brain state not just the brain state as it is.
"Our goal is to create a brain signature specific to an individual and then tailor treatment accordingly," said Dr. Etkin. "Ultimately, we hope to have a clinic-ready tool that will dramatically change how we care for patients with post-traumatic stress."
PTSD is a chronic disease that in some individuals lasts a lifetime. Existing treatment, including cognitive processing therapy, prolonged exposure therapy, and medication (there are only two medications for the treatment of PTSD which were approved by the FDA some 15 years ago), has not been effective in the majority of patients. According to a study published in JAMA last year, as many as two-thirds of veterans receiving CPT or PE keep their PTSD diagnosis after treatment, even if their symptoms initially improve.
"All we currently have is a one-size fits all approach to treatment. While this approach is not effective, we do not yet have reliable predictors for who will respond to treatment. Some patients will do very well with PE but for those who do not, we need to be able to know definitively and early on so that we can offer alternative options," said Dr. Etkin.
"Post-traumatic stress presents in patients in a myriad of ways, which underscores the need for individualizing treatment," said Magali Haas, M.D., Ph.D., CEO & president of Cohen Veterans Bioscience. "Our collaboration with the talented team at Stanford and the VA will lead us one step closer to understanding the mechanisms underlying PTSD in specific individuals, which is critical if we are to develop diagnostic tests that can provide accurate diagnoses, new treatments, and tools to measure the effectiveness of a given treatment."
According to the U.S. Department of Veterans Affairs National Center for PTSD, approximately 7 or 8 out of every 100 people will experience PTSD at some point during their lives. About 8 million adults have PTSD in a given year.