Treating Stress in Patients in Europe

Peter O'Donnell
New perspectives are opening up for pharmacological treatment of post-traumatic stress disorder (PTSD), according to the European Medicines Agency (EMEA). So far, drug treatment options for this severe and prevalent pathology have been limited.

Serotoninergic agents, tricyclic antidepressants, mood stabilizers, adrenergic inhibiting agents, antipsychotics, and benzodiazepines have all been proposed for controlling symptoms, but to date only sertraline and paroxetine have been authorized for treatment. But the prospects are now "potentially promising," says EMEA, presenting a new guideline on the planning of studies in this area.

As the agency points out, numerous biological dysregulations are being identified among PTSD patients, covering the opioid, glutaminergic, noradrenergic, and serotoninergic neurotransmitter systems, resulting in neuro-endocrinological disturbances and physiological symptoms. Neuroimaging studies in PTSD show alterations in brain function in the medial prefrontal cortex, hippocampus, thalamus, amygdala, anterior cingulated gyrus, temporal cortex, and visual association cortex.

However, advances in understanding the disorder "also raise the question of how to deal with the complexity," the agency observes. The clinical response to a medicinal product could depend on its pharmacological properties, on the time to treatment after exposure to the trauma, on the type of trauma, and on predominant symptoms. Further challenges include the high prevalence of co-morbid depression, substance abuse, and anxiety disorders and the diagnostic criteria to be used. Hence the guideline.