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キーワード:
Oxytocin, PTSD, Randomized controlled trial (RCT), Script-driven trauma imagery, Symptom provocation study, Intranasal pharmacotherapy, Psychophysiology, Trier Social Stress Test
要旨:
Background: Posttraumatic stress disorder (PTSD) is a severe psychiatric
disease accompanied by neuroendocrine changes such as adrenergic
overdrive and hence an elevated cardiovascular morbidity. Current
pharmacotherapeutic options for PTSD are less than suboptimal,
necessitating the development of PTSD-specific drugs. Although the
neuropeptide oxytocin has been repeatedly suggested to be effective in
PTSD treatment, there are, to our knowledge, only three studies that
have assessed its efficacy on the intensity of PTSD symptoms in PTSD
patients - among them one symptom provocation study in male veterans.
Methods: To evaluate for the first time how oxytocin influences the
intensity of provoked PTSD symptoms and, furthermore, cardiac control in
female PTSD patients, we assessed their psychic and cardiac response to
trauma-script exposure with and without oxytocin pretreatment in a
double-blind randomized placebo-controlled study. We used a
within-subject design to study 35 female PTSD patients who received
oxytocin and placebo in a 2-week interval. Furthermore, we performed a
small pilot study to get an idea of the relation of the stress-modulated
endogenous oxytocin levels and heart rate - we correlated oxytocin serum
levels with the heart rate of 10 healthy individuals before and after
exposure to the Trier Social Stress Test (TSST).
Results: Intranasal oxytocin treatment was followed by a reduction of
provoked total PTSD symptoms, in particular of avoidance, and by an
elevation in baseline and maximum heart rate together with a drop in the
pre-ejection period, a marker for sympathetic cardiac control.
Furthermore, we found a positive correlation between endogenous oxytocin
levels and heart rate both before and after TSST challenge in healthy
control subjects.
Conclusions: This study provides the first evidence that oxytocin
treatment reduces the intensity of provoked PTSD symptoms in female PTSD
patients. The small size of both samples and the heterogeneity of the
patient sample restrict the generalizability of our findings. Future
studies have to explore the gender dependency and the tolerability of
the oxytocin- mediated increase in heart rate.
