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Papini S, Sullivan GM, Hien DA, Shvil E, Neria Y. Toward a translational approach to targeting the endocannabinoid system in posttraumatic stress disorder: a critical review of preclinical research. Biol Psychol 2014; 104:8-18. [PMID: 25448242 DOI: 10.1016/j.biopsycho.2014.10.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 10/18/2014] [Accepted: 10/27/2014] [Indexed: 12/12/2022]
Abstract
Despite the lack of clinical research, marijuana and synthetic cannabinoids have been approved to treat posttraumatic stress disorder (PTSD) in several states in the United States. This review critically examines preclinical research on the endocannabinoid system (ECS) in order to evaluate three key questions that are relevant to PTSD: (1) Does ECS dysfunction impact fear extinction? (2) Can stress-related symptoms be prevented by ECS modulation? (3) Is the ECS a potential target for enhancing PTSD treatment? Disruption of the ECS impaired fear extinction in rodents, and ECS abnormalities have been observed in PTSD. Targeting fear memories via the ECS had mixed results in rodents, whereas augmented cannabinoid receptor activation typically facilitated extinction. However, the translational value of these findings is limited by the paucity and inconsistency of human research. Further investigation is necessary to determine whether incorporating cannabinoids in treatment would benefit individuals with PTSD, with cautious attention to risks.
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Affiliation(s)
- Santiago Papini
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA; City College of New York, 160 Convent Avenue, New York, NY, 10031, USA; Columbia University Medical Center, W. 168th Street, New York, NY, 10032, USA
| | - Gregory M Sullivan
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA; Columbia University Medical Center, W. 168th Street, New York, NY, 10032, USA
| | - Denise A Hien
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA; City College of New York, 160 Convent Avenue, New York, NY, 10031, USA; Columbia University Medical Center, W. 168th Street, New York, NY, 10032, USA
| | - Erel Shvil
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA; Columbia University Medical Center, W. 168th Street, New York, NY, 10032, USA
| | - Yuval Neria
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA; Columbia University Medical Center, W. 168th Street, New York, NY, 10032, USA.
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Korem N, Akirav I. Cannabinoids prevent the effects of a footshock followed by situational reminders on emotional processing. Neuropsychopharmacology 2014; 39:2709-22. [PMID: 24897957 PMCID: PMC4200492 DOI: 10.1038/npp.2014.132] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 05/06/2014] [Accepted: 05/30/2014] [Indexed: 01/04/2023]
Abstract
Posttraumatic stress disorder (PTSD) can develop following exposure to a traumatic event. Hence, what we do in the first few hours after trauma exposure may alter the trajectory of PTSD. We examined whether cannabinoids can prevent the effects of a single footshock followed by situational reminders (SRs) on emotional processing. Rats were exposed to a footshock (1.5 mA, 10 s) on day 1 followed by exposure to SRs of the shock on days 3 and 5. The CB1/2 receptor agonist WIN55,212-2 or vehicle were injected intraperitoneally 2 h after the shock. After 1 week, PTSD-like symptoms were examined. Exposure to SRs exacerbated the effects of the shock as rats exposed to shock and SRs, but not shock alone, showed impaired extinction of the traumatic event, impaired plasticity in the hippocmapal-accumbens pathway, enhanced latency to startle, and altered expression of CB1 receptors (CB1r) and glucocorticoid receptors (GRs) in the CA1, basolateral amygdala (BLA) and prefrontal cortex (PFC). WIN55,212-2 prevented the effects of the shock and SRs on extinction, plasticity, and startle response. WIN55,212-2 normalized the shock/SR-induced upregulation in CB1r in the PFC, and CA1 and GRs in the CA1, with no effect on BLA downregulation of CB1r and GRs. Shock and SRs caused lasting (1 week) alterations in emotional processing associated with changes in GR and CB1r expression in brain areas related to PTSD. WIN55,212-2 administered after trauma exposure prevented these alterations via PFC- and CA1-CB1r and CA1-GRs.
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Affiliation(s)
- Nachshon Korem
- Department of Psychology, University of Haifa, Haifa, Israel
| | - Irit Akirav
- Department of Psychology, University of Haifa, Haifa, Israel,Department of Psychology, University of Haifa, Mount Carmel, Haifa 31905, Israel, Tel: +972 4 8288268, Fax: +972 4 8263157, E-mail:
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Graham BM, Callaghan BL, Richardson R. Bridging the gap: Lessons we have learnt from the merging of psychology and psychiatry for the optimisation of treatments for emotional disorders. Behav Res Ther 2014; 62:3-16. [DOI: 10.1016/j.brat.2014.07.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 07/15/2014] [Accepted: 07/16/2014] [Indexed: 02/08/2023]
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Klasen M, Kreifelts B, Chen YH, Seubert J, Mathiak K. Neural processing of emotion in multimodal settings. Front Hum Neurosci 2014; 8:822. [PMID: 25374523 PMCID: PMC4204532 DOI: 10.3389/fnhum.2014.00822] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 09/26/2014] [Indexed: 02/04/2023] Open
Affiliation(s)
- Martin Klasen
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University Aachen, Germany ; Jülich Aachen Research Alliance-Translational Brain Medicine, RWTH Aachen University Aachen, Germany
| | - Benjamin Kreifelts
- Department of Psychiatry and Psychotherapy, University of Tuebingen Tuebingen, Germany
| | - Yu-Han Chen
- Department of Psychiatry, The University of New Mexico School of Medicine Albuquerque, NM, USA
| | - Janina Seubert
- Psychology Division, Department of Clinical Neuroscience, Karolinska Institutet Stockholm, Sweden
| | - Klaus Mathiak
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University Aachen, Germany ; Jülich Aachen Research Alliance-Translational Brain Medicine, RWTH Aachen University Aachen, Germany
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Dunkley BT, Doesburg SM, Sedge PA, Grodecki RJ, Shek PN, Pang EW, Taylor MJ. Resting-state hippocampal connectivity correlates with symptom severity in post-traumatic stress disorder. NEUROIMAGE-CLINICAL 2014; 5:377-84. [PMID: 25180157 PMCID: PMC4145533 DOI: 10.1016/j.nicl.2014.07.017] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 07/07/2014] [Accepted: 07/30/2014] [Indexed: 01/16/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a serious mental health injury which can manifest after experiencing a traumatic life event. The disorder is characterized by symptoms of re-experiencing, avoidance, emotional numbing and hyper-arousal. Whilst its aetiology and resultant symptomology are better understood, relatively little is known about the underlying cortical pathophysiology, and in particular whether changes in functional connectivity may be linked to the disorder. Here, we used non-invasive neuroimaging with magnetoencephalography to examine functional connectivity in a resting-state protocol in the combat-related PTSD group (n = 23), and a military control group (n = 21). We identify atypical long-range hyperconnectivity in the high-gamma-band resting-state networks in a combat-related PTSD population compared to soldiers who underwent comparable environmental exposure but did not develop PTSD. Using graph analysis, we demonstrate that apparent network connectivity of relevant brain regions is associated with cognitive-behavioural outcomes. We also show that left hippocampal connectivity in the PTSD group correlates with scores on the well-established PTSD Checklist (PCL). These findings indicate that atypical synchronous neural interactions may underlie the psychological symptoms of PTSD, whilst also having utility as a potential biomarker to aid in the diagnosis and monitoring of the disorder. Soldiers with PTSD display increased connectivity in high gamma resting state. Left frontal, temporal and hippocampus regions show hyperconnectivity in PTSD. Emotionally-salient stimuli induced increased connectivity in soldiers without PTSD. Connectivity strength in left hippocampus correlates with PTSD symptom severity.
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Affiliation(s)
- B T Dunkley
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada ; Neuroscience & Mental Health Program, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - S M Doesburg
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada ; Neuroscience & Mental Health Program, The Hospital for Sick Children Research Institute, Toronto, Canada ; Department of Medical Imaging, University of Toronto, Toronto, Canada ; Department of Psychology, University of Toronto, Toronto, Canada
| | - P A Sedge
- Directorate of Mental Health, Canadian Forces Health Services, Ottawa, Canada
| | - R J Grodecki
- Canadian Forces Environmental Medicine Establishment, Toronto, Canada
| | - P N Shek
- Defence Research and Development Canada, Toronto, Canada
| | - E W Pang
- Neuroscience & Mental Health Program, The Hospital for Sick Children Research Institute, Toronto, Canada ; Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - M J Taylor
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada ; Neuroscience & Mental Health Program, The Hospital for Sick Children Research Institute, Toronto, Canada ; Department of Medical Imaging, University of Toronto, Toronto, Canada ; Department of Psychology, University of Toronto, Toronto, Canada
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