Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran.
Faculty of Medicine, Qazvin University of Medical Science, Qazvin, Iran.
Brain Behav. 2023 Dec;13(12):e3292. doi: 10.1002/brb3.3292. Epub 2023 Oct 20.
Posttraumatic stress disorder (PTSD) is a complex and heterogeneous mental health condition that can develop after exposure to a traumatic event. Clinical trials have used alternative pharmacological agents to treat PTSD, but their associated neural correlates remain unclear. The present systematic review aims to summarize the changes in brain function associated with the use of these alternative pharmacological agents in PTSD.
Clinical trials using functional magnetic resonance imaging, either at rest or during the performance of tasks, were included if they compared the effects of alternative pharmacological agents between PTSD patients and either trauma-exposed controls or never-exposed healthy controls.
Sixteen studies were included, of which 11 used intranasal oxytocin, 2 used hydrocortisone, and 3 used delta-9-tetrahydrocannabinol (THC). Oxytocin administration was associated with the normalization of functional connectivity between the ventromedial prefrontal cortex and amygdala as well as enhanced the function of brain regions specifically involved in emotion processing (e.g., amygdala), working memory (e.g., dorsolateral prefrontal cortex), and reward (e.g., putamen). Hydrocortisone did not influence brain function at rest or during the performance of an autobiographical memory task, whereas THC was associated with the reduction of the amygdala and increased medial prefrontal cortex activation.
This systematic review identified preliminary evidence for normalizing brain function after the use of alternative pharmacological agents. Importantly, sex-specific differences were noted, in particular when using oxytocin, that will require further investigation.
创伤后应激障碍（PTSD）是一种复杂的、异质的心理健康状况，可能在经历创伤性事件后发展而来。临床试验已经使用替代药物来治疗 PTSD，但它们相关的神经相关性仍不清楚。本系统评价旨在总结这些替代药物治疗 PTSD 时与大脑功能变化相关的研究。
如果临床试验使用功能磁共振成像，无论是在静息状态下还是在执行任务时，并且比较了 PTSD 患者与创伤暴露对照组或从未暴露于健康对照组之间替代药物的效果，则将其纳入研究。
共纳入了 16 项研究，其中 11 项使用了鼻内催产素，2 项使用了氢化可的松，3 项使用了大麻二酚（THC）。催产素给药与腹内侧前额叶皮层和杏仁核之间功能连接的正常化有关，并且增强了专门参与情绪处理（例如杏仁核）、工作记忆（例如背外侧前额叶皮层）和奖励（例如壳核）的大脑区域的功能。氢化可的松在静息或执行自传体记忆任务时均未影响大脑功能，而 THC 与杏仁核减少和内侧前额叶皮层激活增加有关。
本系统评价初步确定了使用替代药物治疗后大脑功能正常化的证据。值得注意的是，尤其是在使用催产素时，注意到了性别特异性差异，这需要进一步研究。
