PTSD Treatment Research Begins to Target Memory Reconsolidation

MONTREAL – The field of psychiatry is facing a paradigm shift with new research suggesting that medications and psychotherapy may be able to permanently erase the “trauma” from traumatic memories, according to several experts.

The experimental treatment, known as reconsolidation blockade, has been shown to interrupt the neurobiologic process of memory formation.

“We do not erase people’s memories,” Alain Brunet, Ph.D., said at the annual meeting of the International Society for Traumatic Stress Studies. Dr. Brunet of the department of psychiatry at McGill University, Montreal, is one of the first researchers to report results of the treatment in patients with posttraumatic stress disorder (PTSD).

Rather than erasing an entire memory, reconsolidation blockade appears to erase the emotional reaction to the memory, explained Dr. Roger K. Pitman, director of the posttraumatic stress disorder and psychophysiology laboratory at Massachusetts General Hospital and professor of psychiatry at Harvard Medical School, both in Boston.

The treatment, which normally involves two doses of the beta-blocker propranolol administered between 75 minutes and 2 hours apart, is “pioneering” in that it upends traditional theories about the permanence of memory, said Dr. Charles Marmar, professor and chair of the department of psychiatry and director of the Trauma Research Group at New York University.

Traditional cognitive-behavioral treatment for PTSD is based on the premise that traumatic memory is permanent, and therefore therapy should focus on learning a less emotional response to it, explained Gregory Quirk, Ph.D., professor of psychiatry and director of the laboratory of fear learning at the University of Puerto Rico, San Juan.

This learned response, known as “extinction,” changes the body’s physiologic, amygdala-based memory, and teaches a cognitive, hippocampal response to the memory instead, he said. “With extinction, you reroute the stimulus so it does not go to the amygdala. You’re teaching the brain – it’s a learned thing – but the original memory is still in the amygdala somewhere. Extinction does not alter the original memory – we know that from Pavlov.” Extinction works well in certain psychiatric conditions, such as phobia, but people with PTSD have hippocampal and prefrontal deficits that frequently cause extinction failure, he said.

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