title: Emotion Regulatory Brain Function and SSRI Treatment in PTSD: Neural Correlates and Predictors of Change.
abstract: Posttraumatic stress disorder (PTSD)-a chronic, debilitating condition, broadly characterized by emotion dysregulation-is prevalent among US military personnel who have returned from Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF). Selective serotonin reuptake inhibitors (SSRIs) are a first-line treatment for PTSD, but treatment mechanisms are unknown and patient response varies. SSRIs may exert their effects by remediating emotion regulatory brain activity and individual differences in patient response might be explained, in part, by pre-treatment differences in neural systems supporting the downregulation of negative affect. Thirty-four OEF/OIF veterans, 17 with PTSD and 17 without PTSD underwent 2 functional magnetic resonance imaging scans 12 weeks apart. At each scan, they performed an emotion regulation task; in the interim, veterans with PTSD were treated with the SSRI, paroxetine. SSRI treatment increased activation in both the left dorsolateral prefrontal cortex (PFC) and supplementary motor area (SMA) during emotion regulation, although only change in the SMA over time occurred in veterans with PTSD and not those without PTSD. Less activation of the right ventrolateral PFC/inferior frontal gyrus during pre-treatment emotion regulation was associated with greater reduction in PTSD symptoms with SSRI treatment, irrespective of pre-treatment severity. Patients with the least recruitment of prefrontal emotion regulatory brain regions may benefit most from treatment with SSRIs, which appear to augment activity in these regions.
authors.affiliation: Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Annmarie
authors.initials: A
authors.lastname: MacNamara
authors.affiliation: Department of Pharmacy Practice, Wayne State University, Detroit, MI, USA.|Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Rabinak
authors.affiliation: Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.|Mental Health Service Line, Jesse Brown VA Medical Center, Chicago, IL, USA.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Kennedy
authors.affiliation: Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.|Mental Health Service Line, Jesse Brown VA Medical Center, Chicago, IL, USA.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Fitzgerald
authors.affiliation: Department of Psychiatry, University of Michigan and Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.|Department of Psychology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Israel
authors.identifier: http://orcid.org/0000-0002-4990-556X
authors.initials: I
authors.lastname: Liberzon
authors.affiliation: Department of Psychiatry, University of California at San Diego, San Diego, CA, USA.|Department of Family Medicine and Public Health, University of California at San Diego, San Diego, CA, USA.|VA San Diego Healthcare System, San Diego, CA, USA.
authors.forename: Murray B
authors.initials: MB
authors.lastname: Stein
authors.affiliation: Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.|Mental Health Service Line, Jesse Brown VA Medical Center, Chicago, IL, USA.|Department of Psychology and the Graduate Program in Neuroscience, University of Illinois at Chicago, Chicago, IL, USA.|Department of Anatomy and Cell Biology, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: K Luan
authors.initials: KL
authors.lastname: Phan
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D001921:Brain / Q000187:drug effects* / Q000503:physiopathology; D001931:Brain Mapping; D002560:Cerebrovascular Circulation / Q000187:drug effects / Q000502:physiology; D003071:Cognition / Q000187:drug effects / Q000502:physiology; D004644:Emotions / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D054542:Iraq War, 2003-2011; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D010100:Oxygen / Q000097:blood; D017374:Paroxetine / Q000009:adverse effects / Q000627:therapeutic use*; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome; D014728:Veterans / Q000523:psychology; D000067453:War Exposure / Q000009:adverse effects
chemical_list: D010100:Oxygen; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors