title: Can pharmacological and psychological treatment change brain structure and function in PTSD? A systematic review.
abstract: While there is evidence of clinical improvement of posttraumatic stress disorder (PTSD) with treatment, its neural underpinnings are insufficiently clear. Moreover, it is unknown whether similar neurophysiological changes occur in PTSD specifically after child abuse, given its enduring nature and the developmental vulnerability of the brain during childhood. We systematically reviewed PTSD treatment effect studies on structural and functional brain changes from PubMed, EMBASE, PsycINFO, PILOTS and the Cochrane Library. We included studies on adults with (partial) PTSD in Randomized Controlled Trials (RCT) or pre-post designs (excluding case studies) on pharmacotherapy and psychotherapy. Risk of bias was evaluated independently by two raters. Brain coordinates and effect sizes were standardized for comparability. We included 15 studies (6 RCTs, 9 pre-post), four of which were on child abuse. Results showed that pharmacotherapy improved structural abnormalities (i.e., increased hippocampus volume) in both adult-trauma and child abuse related PTSD (3 pre-post studies). Functional changes were found to distinguish between groups. Adult-trauma PTSD patients showed decreased amygdala and increased dorsolateral prefrontal activations post-treatment (4 RCTs, 5 pre-post studies). In one RCT, child abuse patients showed no changes in the amygdala, but decreased dorsolateral prefrontal, dorsal anterior cingulate and insula activation post-treatment. In conclusion, pharmacotherapy may reduce structural abnormalities in PTSD, while psychotherapy may decrease amygdala activity and increase prefrontal, dorsal anterior cingulate and hippocampus activations, that may relate to extinction learning and re-appraisal. There is some evidence for a distinct activation pattern in child abuse patients, which clearly awaits further empirical testing.
authors: GGZ InGeest/Dept. of Psychiatry, VU University Medical Center (VUmc), Amsterdam, The Netherlands; Neuroscience Campus, Amsterdam, The Netherlands. Electronic address: k.thomaes@vumc.nl.
authors: Kathleen
authors: K
authors: Thomaes
authors: GGZ InGeest/Dept. of Psychiatry, VU University Medical Center (VUmc), Amsterdam, The Netherlands; EMGO Institute, VUmc, Amsterdam, The Netherlands; PsyQ, Parnassia Bavo Group, Den Haag, The Netherlands.
authors: Ethy
authors: E
authors: Dorrepaal
authors: GGZ InGeest/Dept. of Psychiatry, VU University Medical Center (VUmc), Amsterdam, The Netherlands; EMGO Institute, VUmc, Amsterdam, The Netherlands.
authors: Nel
authors: N
authors: Draijer
authors: Medical Library UB VU, Amsterdam, The Netherlands.
authors: Elise P
authors: EP
authors: Jansma
authors: GGZ InGeest/Dept. of Psychiatry, VU University Medical Center (VUmc), Amsterdam, The Netherlands; Neuroscience Campus, Amsterdam, The Netherlands; AMC Academic Psychiatric Center, AIAR, Amsterdam, The Netherlands.
authors: Dick J
authors: DJ
authors: Veltman
authors: GGZ InGeest/Dept. of Psychiatry, VU University Medical Center (VUmc), Amsterdam, The Netherlands; EMGO Institute, VUmc, Amsterdam, The Netherlands.
authors: Anton J
authors: AJ
authors: van Balkom
mesh_terms: D000328:Adult; D000818:Animals; D001921:Brain / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology*; D002648:Child; D002649:Child Abuse; D006801:Humans; D009473:Neuronal Plasticity / Q000187:drug effects; D011613:Psychotherapy; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*
keywords: Child abuse; Neuroimaging treatment outcome; Pharmacotherapy; Posttraumatic stress disorder; Psychotherapy