Can Medications Help Make PTSD Treatment More Effective?

What you need to know

• Two medications - hydrocortisone and D-cycloserine - may help enhance fear extinction, a key process in PTSD treatment
• Both medications improved participants’ ability to “unlearn” fear responses in laboratory tests
• While promising, more research is needed to determine if these medications can improve real-world PTSD treatment outcomes

The Challenge of Treating PTSD

Imagine trying to unlearn a deeply ingrained fear response - like flinching every time you hear a loud noise after experiencing combat trauma. This process of “unlearning” fear is called fear extinction, and it’s a crucial part of exposure therapy, one of the most effective treatments for Post-Traumatic Stress Disorder (PTSD). However, many people with PTSD have difficulty with fear extinction, which may explain why some don’t fully recover with standard treatment.

Understanding Fear Extinction

Fear extinction occurs when we learn that something we previously associated with danger (like loud noises) is actually safe. In exposure therapy, patients gradually confront feared situations in a safe environment to promote this learning process. However, research shows that people with PTSD often have impaired fear extinction abilities compared to those without PTSD.

How Medications Might Help

Researchers have been exploring whether certain medications could enhance fear extinction learning. This study examined two promising candidates:

• Hydrocortisone: A synthetic form of cortisol, our body’s primary stress hormone
• D-cycloserine: A medication that affects glutamate, a brain chemical involved in learning

The study involved 90 people with PTSD symptoms who underwent a laboratory fear conditioning procedure. Participants first learned to associate a particular image with a mild electric shock. Later, they took either hydrocortisone, D-cycloserine, or a placebo before attempting to unlearn this fear association.

What the Research Found

Both medications showed promising results. Participants who took either hydrocortisone or D-cycloserine showed better fear extinction learning compared to those who took a placebo. The D-cycloserine group also showed some evidence of better retention of this learning one week later, though this finding wasn’t statistically significant.

What This Means for You

If you or someone you know has PTSD, these findings suggest that medications might eventually help make exposure therapy more effective. However, it’s important to note that:

• This was a laboratory study using controlled conditions
• More research is needed to determine if these benefits translate to real-world treatment
• Any new medication approaches would need to be carefully tested for safety and effectiveness
• These medications would likely be used as supplements to, not replacements for, therapy

Conclusions

• Both hydrocortisone and D-cycloserine show promise for enhancing fear extinction learning in people with PTSD
• These medications might eventually be used alongside exposure therapy to improve treatment outcomes
• While encouraging, more research is needed before these approaches could be implemented in clinical practice