Mental Health Service Line, Minneapolis VA Health Care System, Minneapolis, MN, United States of America; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America; Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN, United States of America.
2 papers in the library · 16 citations · publishing 2024
Meditation-based therapies such as mindfulness-based stress reduction and Transcendental Meditation can reduce PTSD symptoms in veterans. In 72 veterans with PTSD, those with the 5HTTLPR LALA high expression genotype of the serotonin transporter gene who had experienced early life trauma showed greater symptom improvement. Additionally, changes in DNA methylation at nine specific sites in the FKBP5 gene from before to after treatment were linked to greater symptom improvement, with an odds ratio of 2.8. These findings suggest that genetic and epigenetic markers in the SLC6A4 and FKBP5 genes may be important for understanding treatment mechanisms and predicting symptom improvement.
Trauma-focused therapies like Prolonged Exposure (PE) are recommended over medication for PTSD, but 30% to 50% of military and veteran patients do not show meaningful symptom improvement. Ketamine, an anesthetic that affects glutamate signaling, has shown in preclinical studies to improve extinction learning and reduce fear renewal. A planned randomized controlled trial will compare three ketamine infusions to an active placebo (midazolam) given alongside PE therapy in veterans with PTSD. Infusions occur 24 hours before PE sessions for the first three weeks. Out of 100 veterans, 80 are expected to reach the primary outcome assessment. Secondary outcomes include depression, anxiety, safety, cognition, and dropout rates. Results may clarify which components are essential and which patients benefit most.