Morphine treatment linked to the prevention of PTSD

That conclusion is based on findings published Thursday in the New England Journal of Medicine. They suggest that a simple treatment can stop a single horrifying event from escalating into a chronic, incapacitating illness.

Small clinical trials and observational studies have hinted that opiates and other medications could disrupt the way the brain encodes traumatic memories, thus preventing the incidents from being recorded with too much intensity. The new findings — troops who received morphine within a few hours of their injuries were about 50 percent less likely to develop PTSD than those who didn't get the powerful pain-killer — are a strong endorsement of that theory.

The results underscore the potential for a pre-emptive treatment, not just for soldiers, but for victims of wars, natural disasters, physical abuse, violent crimes such as rape, and traumatic accidents.

PTSD is a relatively common disorder in which stress seems to cause normal memory systems to go into overdrive. It can cause vivid flashbacks, sleeping difficulties, and problems with personal relationships. Symptoms can begin soon after a traumatic event or not until years later.

“We're all worried about the mounting incidence of PTSD among our troops, as well as the incidence in the civilian sector,” said Dr. Matthew J. Friedman, executive director of the Veteran Administration's National Center for Posttraumatic Stress Disorder in White River Junction, Vt., who wasn't involved in the study. “If there were something we could do to prevent that, why wouldn't we do it?”

More than 40,000 military personnel have been diagnosed with PTSD since the 2003 invasion of Iraq, and Defense Department officials say many more surely have the disorder but have not sought treatment.

Overall, experts estimate that about 20 percent of troops and veterans suffer from PTSD, along with 8 percent of civilians.

Treatment usually involves talk therapy to help patients change the way they react to painful memories; and antidepressants and other medications can sometimes ease symptoms. But these approaches leave much to be desired.

“PTSD right now is really difficult to treat, so if we had a prevention, we'd want to use it,” said Dr. Murray Stein, a University of California, San Diego psychiatrist and director of the Injury and Traumatic Stress Clinical Consortium, which is funded by the Defense Department.

Psychiatrists and neuroscientists aren't sure why some people develop PTSD while others don't, but the leading theory is that having too much of the stress hormone norepinephrine at the time of a traumatic event causes the brain to malfunction when it records the memory.

The idea behind the preventive treatment approach is to disrupt the transmission of norepinephrine in the brain, either by blocking its release or by preventing it from binding to a receptor. In either case, a drug would have to be administered very quickly, while the memory was still being encoded.

The first hint that morphine could serve that purpose came about 10 years ago.

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