From: Wade Smith (email@example.com)
Date: Fri 08 Nov 2002 - 14:06:17 GMT
Pill to ease memory of trauma envisioned
By Ellen Barry, Globe Staff, 11/8/2002
Someday in the future, people may walk into an emergency room after a
rape, or a car wreck, or a shooting, and be given a pill to protect them
from the haunting memories that may follow.
For millions of war veterans, abuse victims, and others, the
psychological shock following a traumatic event can be as damaging as
the event itself. Post-traumatic stress disorder, which affects an
estimated 3 to 8 percent of the population, is typically treated with
therapy to help the victim live with the memory.
But a researcher from Boston University will present research today that
suggests doctors can keep a traumatic memory from being engraved vividly
into the victim's mind in the first place. Instead of revisiting the
victim as an intrusive flashback, the memory of trauma would be more
like recollections of ordinary events.
He and another researcher, working independently, are planning human
trials to test their early findings that drugs commonly prescribed for
hypertension could lessen the effects of Post-Traumatic Stress Disorder,
''It would have enormous public health relevance,'' said Dr. Glenn Saxe,
the chairman of child and adolescent psychiatry at Boston Medical
Center, who will present his findings today in Baltimore to the world's
largest yearly meeting of traumatic stress specialists. If human trials
confirm his observations, such drugs could be administered routinely in
emergency rooms ''not unlike [anticlotting agents] are given to heart
attack victims,'' he said.
Both Saxe and Dr. Roger Pitman, a professor of psychiatry at Harvard
Medical School, believe that by dampening the body's adrenaline-fueled
''fight-or-flight'' reaction to great stress - and specifically by suppressing the neurotransmitter norepinephrine - they can prevent the vivid memories characteristic of PTSD. Saxe's human trials will test the long-term effect of the blood-pressure medication clonidine, which suppresses norepinephrine, on children who have survived trauma.
The theory has grown out of expanding knowledge of the process of memory
Using drugs to help prevent PTSD, however, may not meet with universal
enthusiasm among doctors who treat trauma. Although the terrorist
attacks on Sept. 11 of last year have made PTSD an increasingly familiar
diagnosis, much of its biology and physiology is still mysterious. It is
unknown, for example, why one person recovers beautifully and another,
who at first appears calmer, may be haunted for years.
For that reason, scientists should be cautious about affecting natural
coping mechanisms, said one trauma specialist.
''I am someone who believes you have to do that really carefully,
because if nature is giving us adrenaline at a time like this, there's a
reason for it,'' said Rachel Yehuda, director of the Traumatic Stress
Studies division at the Mount Sinai School of Medicine. ''If medication
delays your dealing with the event, maybe you'll pay for it later.''
But others interviewed said the medications are a promising new
direction. In both humans and animals, memory is heightened and enhanced
by certain kinds of stress or fear. A group of college students tested
by researchers at the University of California at Irvine, for example,
could remember a series of slides better when they were accompanied by
an upsetting or frightening story.
The best explanation for this hinges on the rush of stress hormones -
including adrenaline and norepinephrine - whose release in the brain is
triggered by fear, causing vision to improve, pupils to dilate, and the
heart to pump harder. When they reach an area of the brain called the
amygdala, known as the brain's ''fear center,'' those hormones also
enhance memory, which explains why years or even decades later, people
can remember precisely where they were when they received catastrophic
''If you had a memory for every time you tied your shoe that was as
strong as a memory for when you hear a loved one has died, you can see
the importance of a built-in biological system that weighs memory
storage according to importance,'' said Larry Cahill, an assistant
professor of neurobiology and behavior at UC Irvine, who designed the
study of college students' memory.
But enhanced memory, an evolutionary trait that served to teach our
ancestors to avoid threatening situations in the future, may sometimes
''overshoot ... that system'' to cause PTSD, said Pitman.
So the scientists decided to try blocking the stress reaction. Cahill
took the group of students who saw the slides along with a disturbing
narrative and gave them popranolol. This time, their memories were only
as good as those of their non-frightened counterparts.
Cahill and a colleague found the same effect when they gave popranolol
to a 44-year-old woman for three months following a car accident.
Although she had been severely traumatized by earlier car accidents, she
reported this time that she wasn't ''locking [herself] in the house''
and ''traffic doesn't rattle [her] this time,'' according to a report in
the October Journal of Traumatic Stress. Meanwhile, in Boston, Pitman
was doing a pilot study of 40 people recruited in the emergency room of
Massachusetts General Hospital. A month after undergoing a 10-day
course, none of eight subjects treated with popranolol had a stressful
physical response to re-creations of the traumatic event, whereas six of
14 subjects treated with a placebo did.
Although the terrorist attacks opened up a huge commercial market for
some therapies for PTSD - such as the antidepressant Paxil or crisis
debriefing - Pitman said he and his colleagues are hoping to support
their work with grants rather than pharmaceutical company money. Since
the medications the researchers are using are no longer subject to
patent, he said, there's ''not going to be drug company money
But considering the cost of treating full-blown PTSD, and the substance
abuse that goes along with it, any preventive measures will save money
on a national scale, said Lisa Najavits, director of the Trauma Research
Project at McLean Hospital. ''The ultimate question is what prevents
human suffering,'' she said.
Ellen Barry can be reached at firstname.lastname@example.org
This story ran on page A1 of the Boston Globe on 11/8/2002.
© Copyright 2002 Globe Newspaper Company.
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