Post-traumatic stress disorder: the role of the amygdala and potential therapeutic interventions – a review

Summary & key facts

This review looks at how a small brain area called the amygdala, which helps the brain detect and remember threats, is involved in post-traumatic stress disorder (PTSD). The authors say many people with PTSD still do not get better with existing treatments, and that studying amygdala circuits could help find new medicines. They highlight a group of proteins called TRPC ion channels as a possible drug target based on animal studies, and they suggest more research into combining medication with psychotherapy to better manage symptoms.

Key facts:

• PTSD is triggered by exposure to a life-threatening or sexually violent event and causes repeated memories, avoidance, negative thoughts, and being on edge for long periods.
• In U.S. studies, one-year PTSD rates in civilians ranged from about 2% to 9%, and lifetime rates varied widely across studies; the disorder has a large cost to society, estimated at about $232 billion in 2018, or roughly $20,000 per person each year.
• Current drug treatment options are limited: no new medicines for PTSD have been approved in the United States since sertraline in 1999 and paroxetine in 2000.
• Psychotherapy helps many people, but it is not fully effective for everyone: about 60% of clinical-trial participants still met PTSD criteria after cognitive behavioral therapy, and only about one-third to two-thirds reached a sufficient level of functioning.
• A review of brain studies shows the amygdala—an area that encodes fear and threat—often works differently in people with PTSD. Some studies find smaller volumes in parts of the amygdala, and other studies show stronger or changed connections between the amygdala and the frontal brain regions that normally help control emotions.
• The literature is mixed and incomplete: structural imaging studies of amygdala subregions are few and can give conflicting results, so functional brain imaging (which looks at activity and connections) may be more useful for understanding PTSD.
• The authors point to a family of proteins called TRPC ion channels, which are found in the amygdala, as a promising target for new drugs because animal studies link them to how fear responses are regulated.
• The review does not claim that new treatments already work in people; instead it emphasizes that combining better biological knowledge of amygdala circuits with studies of drugs plus psychotherapy is a logical next step for research.

Abstract

In view of the prevalence and economic burden associated with PTSD, further investigation is warranted into novel treatment approaches based on our knowledge of the involvement of brain circuitry and the role of the amygdala in PTSD, as well as the potential added value of combined pharmacotherapy and psychotherapy to better manage PTSD symptoms.

Topics

Memory and Neural Mechanisms Nicotinic Acetylcholine Receptors Study Stress Responses and Cortisol

Categories

Cognitive Neuroscience Life Sciences Neuroscience

Tags

Amygdala Anxiety Clinical psychology Dysfunctional family Exposure therapy Medicine Neuroscience Pharmacotherapy Psychiatry Psychological intervention Psychology Traumatic stress

Conditions & symptoms

Anxiety PTSD Anxiety or worry Difficulty focusing Feeling disconnected from others Poor sleep