The Efficacy of a Single Dose of Intranasal Oxytocin in the Prevention of Post Traumatic Stress Disorder (PTSD)

Summary

This study is designed to test the hypothesis that a single administration of intranasal oxytocin within 6 hours post-trauma facilitates the physiological recovery for the trauma, thereby preventing the development of Post Traumatic Stress Disorder (PTSD) in the months following the event. In the absence of such treatment (i.e., under placebo conditions), we hypothesize that a greater proportion of persons will develop PTSD (i.e., fail to recover from acute effects).

Timeline

Start

2010-02

Primary completion

2011-01

Completion

2011-06

Publications

• Background Andrews B, Brewin CR, Rose S, Kirk M. Predicting PTSD symptoms in victims of violent crime: the role of shame, anger, and childhood abuse. J Abnorm Psychol. 2000 Feb;109(1):69-73. doi: 10.1037//0021-843x.109.1.69.
• Background Beckner VE, Tucker DM, Delville Y, Mohr DC. Stress facilitates consolidation of verbal memory for a film but does not affect retrieval. Behav Neurosci. 2006 Jun;120(3):518-27. doi: 10.1037/0735-7044.120.3.518.
• Background Davidson JR, Tupler LA, Wilson WH, Connor KM. A family study of chronic post-traumatic stress disorder following rape trauma. J Psychiatr Res. 1998 Sep-Oct;32(5):301-9. doi: 10.1016/S0022-3956(98)00016-8.
• Background Koenen KC, Harley R, Lyons MJ, Wolfe J, Simpson JC, Goldberg J, Eisen SA, Tsuang M. A twin registry study of familial and individual risk factors for trauma exposure and posttraumatic stress disorder. J Nerv Ment Dis. 2002 Apr;190(4):209-18. doi: 10.1097/00005053-200204000-00001.
• Background Kuhlmann S, Wolf OT. Arousal and cortisol interact in modulating memory consolidation in healthy young men. Behav Neurosci. 2006 Feb;120(1):217-23. doi: 10.1037/0735-7044.120.1.217.
• Background Lupien SJ, Maheu F, Tu M, Fiocco A, Schramek TE. The effects of stress and stress hormones on human cognition: Implications for the field of brain and cognition. Brain Cogn. 2007 Dec;65(3):209-37. doi: 10.1016/j.bandc.2007.02.007. Epub 2007 Apr 26.
• Background Stein MB, Jang KL, Taylor S, Vernon PA, Livesley WJ. Genetic and environmental influences on trauma exposure and posttraumatic stress disorder symptoms: a twin study. Am J Psychiatry. 2002 Oct;159(10):1675-81. doi: 10.1176/appi.ajp.159.10.1675.
• Background Yehuda R, Bierer LM, Schmeidler J, Aferiat DH, Breslau I, Dolan S. Low cortisol and risk for PTSD in adult offspring of holocaust survivors. Am J Psychiatry. 2000 Aug;157(8):1252-9. doi: 10.1176/appi.ajp.157.8.1252.
• Background Yehuda R, Halligan SL, Bierer LM. Relationship of parental trauma exposure and PTSD to PTSD, depressive and anxiety disorders in offspring. J Psychiatr Res. 2001 Sep-Oct;35(5):261-70. doi: 10.1016/s0022-3956(01)00032-2.
• Background Yehuda R, Halligan SL, Grossman R. Childhood trauma and risk for PTSD: relationship to intergenerational effects of trauma, parental PTSD, and cortisol excretion. Dev Psychopathol. 2001 Summer;13(3):733-53. doi: 10.1017/s0954579401003170.
• Background Yehuda R, Harvey PD, Buchsbaum M, Tischler L, Schmeidler J. Enhanced effects of cortisol administration on episodic and working memory in aging veterans with PTSD. Neuropsychopharmacology. 2007 Dec;32(12):2581-91. doi: 10.1038/sj.npp.1301380. Epub 2007 Mar 28.
• Background Yehuda R. Post-traumatic stress disorder. N Engl J Med. 2002 Jan 10;346(2):108-14. doi: 10.1056/NEJMra012941. No abstract available.
• Background Anisman H, Griffiths J, Matheson K, Ravindran AV, Merali Z. Posttraumatic stress symptoms and salivary cortisol levels. Am J Psychiatry. 2001 Sep;158(9):1509-11. doi: 10.1176/appi.ajp.158.9.1509.
• Background Delahanty DL, Raimonde AJ, Spoonster E. Initial posttraumatic urinary cortisol levels predict subsequent PTSD symptoms in motor vehicle accident victims. Biol Psychiatry. 2000 Nov 1;48(9):940-7. doi: 10.1016/s0006-3223(00)00896-9.
• Background Delahanty DL, Raimonde AJ, Spoonster E, Cullado M. Injury severity, prior trauma history, urinary cortisol levels, and acute PTSD in motor vehicle accident victims. J Anxiety Disord. 2003;17(2):149-64. doi: 10.1016/s0887-6185(02)00185-8.
• Background Resnick HS, Yehuda R, Pitman RK, Foy DW. Effect of previous trauma on acute plasma cortisol level following rape. Am J Psychiatry. 1995 Nov;152(11):1675-7. doi: 10.1176/ajp.152.11.1675.
• Background Yehuda R, Bryant R, Marmar C, Zohar J. Pathological responses to terrorism. Neuropsychopharmacology. 2005 Oct;30(10):1793-805. doi: 10.1038/sj.npp.1300816.
• Background Yehuda R, McFarlane AC, Shalev AY. Predicting the development of posttraumatic stress disorder from the acute response to a traumatic event. Biol Psychiatry. 1998 Dec 15;44(12):1305-13. doi: 10.1016/s0006-3223(98)00276-5.
• Background Yehuda R, LeDoux J. Response variation following trauma: a translational neuroscience approach to understanding PTSD. Neuron. 2007 Oct 4;56(1):19-32. doi: 10.1016/j.neuron.2007.09.006.
• Background Charney DS, Deutch AY, Krystal JH, Southwick SM, Davis M. Psychobiologic mechanisms of posttraumatic stress disorder. Arch Gen Psychiatry. 1993 Apr;50(4):295-305. doi: 10.1001/archpsyc.1993.01820160064008. No abstract available.
• Background Yehuda R, Halligan SL, Bierer LM. Cortisol levels in adult offspring of Holocaust survivors: relation to PTSD symptom severity in the parent and child. Psychoneuroendocrinology. 2002 Jan-Feb;27(1-2):171-80. doi: 10.1016/s0306-4530(01)00043-9.
• Background Marmar CR, McCaslin SE, Metzler TJ, Best S, Weiss DS, Fagan J, Liberman A, Pole N, Otte C, Yehuda R, Mohr D, Neylan T. Predictors of posttraumatic stress in police and other first responders. Ann N Y Acad Sci. 2006 Jul;1071:1-18. doi: 10.1196/annals.1364.001.
• Background Neylan TC, Brunet A, Pole N, Best SR, Metzler TJ, Yehuda R, Marmar CR. PTSD symptoms predict waking salivary cortisol levels in police officers. Psychoneuroendocrinology. 2005 May;30(4):373-81. doi: 10.1016/j.psyneuen.2004.10.005. Epub 2005 Jan 11.
• Background Pariante CM, Nemeroff CB, Miller AH. Glucocorticoid receptors in depression. Isr J Med Sci. 1995 Dec;31(12):705-12.
• Background Sautter FJ, Bissette G, Wiley J, Manguno-Mire G, Schoenbachler B, Myers L, Johnson JE, Cerbone A, Malaspina D. Corticotropin-releasing factor in posttraumatic stress disorder (PTSD) with secondary psychotic symptoms, nonpsychotic PTSD, and healthy control subjects. Biol Psychiatry. 2003 Dec 15;54(12):1382-8. doi: 10.1016/s0006-3223(03)00571-7.
• Background Yehuda R, Engel SM, Brand SR, Seckl J, Marcus SM, Berkowitz GS. Transgenerational effects of posttraumatic stress disorder in babies of mothers exposed to the World Trade Center attacks during pregnancy. J Clin Endocrinol Metab. 2005 Jul;90(7):4115-8. doi: 10.1210/jc.2005-0550. Epub 2005 May 3.
• Background Yehuda R, Teicher MH, Seckl JR, Grossman RA, Morris A, Bierer LM. Parental posttraumatic stress disorder as a vulnerability factor for low cortisol trait in offspring of holocaust survivors. Arch Gen Psychiatry. 2007 Sep;64(9):1040-8. doi: 10.1001/archpsyc.64.9.1040.
• Background Cohen H, Zohar J, Gidron Y, Matar MA, Belkind D, Loewenthal U, Kozlovsky N, Kaplan Z. Blunted HPA axis response to stress influences susceptibility to posttraumatic stress response in rats. Biol Psychiatry. 2006 Jun 15;59(12):1208-18. doi: 10.1016/j.biopsych.2005.12.003. Epub 2006 Feb 3.
• Background Harvey BH, Brand L, Jeeva Z, Stein DJ. Cortical/hippocampal monoamines, HPA-axis changes and aversive behavior following stress and restress in an animal model of post-traumatic stress disorder. Physiol Behav. 2006 May 30;87(5):881-90. doi: 10.1016/j.physbeh.2006.01.033. Epub 2006 Mar 6.
• Background Kohda K, Harada K, Kato K, Hoshino A, Motohashi J, Yamaji T, Morinobu S, Matsuoka N, Kato N. Glucocorticoid receptor activation is involved in producing abnormal phenotypes of single-prolonged stress rats: a putative post-traumatic stress disorder model. Neuroscience. 2007 Aug 10;148(1):22-33. doi: 10.1016/j.neuroscience.2007.05.041. Epub 2007 Jul 17.
• Background Mason JW, Giller EL, Kosten TR, Ostroff RB, Podd L. Urinary free-cortisol levels in posttraumatic stress disorder patients. J Nerv Ment Dis. 1986 Mar;174(3):145-9. doi: 10.1097/00005053-198603000-00003.
• Background Yehuda R, Teicher MH, Trestman RL, Levengood RA, Siever LJ. Cortisol regulation in posttraumatic stress disorder and major depression: a chronobiological analysis. Biol Psychiatry. 1996 Jul 15;40(2):79-88. doi: 10.1016/0006-3223(95)00451-3.
• Background Oquendo MA, Echavarria G, Galfalvy HC, Grunebaum MF, Burke A, Barrera A, Cooper TB, Malone KM, John Mann J. Lower cortisol levels in depressed patients with comorbid post-traumatic stress disorder. Neuropsychopharmacology. 2003 Mar;28(3):591-8. doi: 10.1038/sj.npp.1300050. Epub 2002 Aug 19.
• Background Rohleder N, Joksimovic L, Wolf JM, Kirschbaum C. Hypocortisolism and increased glucocorticoid sensitivity of pro-Inflammatory cytokine production in Bosnian war refugees with posttraumatic stress disorder. Biol Psychiatry. 2004 Apr 1;55(7):745-51. doi: 10.1016/j.biopsych.2003.11.018.
• Background Yehuda R. Current status of cortisol findings in post-traumatic stress disorder. Psychiatr Clin North Am. 2002 Jun;25(2):341-68, vii. doi: 10.1016/s0193-953x(02)00002-3.
• Background Bremner JD, Southwick SM, Johnson DR, Yehuda R, Charney DS. Childhood physical abuse and combat-related posttraumatic stress disorder in Vietnam veterans. Am J Psychiatry. 1993 Feb;150(2):235-9. doi: 10.1176/ajp.150.2.235.
• Background Marazziti D, Catena Dell'osso M. The role of oxytocin in neuropsychiatric disorders. Curr Med Chem. 2008;15(7):698-704. doi: 10.2174/092986708783885291.
• Background Heinrichs M, Domes G. Neuropeptides and social behaviour: effects of oxytocin and vasopressin in humans. Prog Brain Res. 2008;170:337-50. doi: 10.1016/S0079-6123(08)00428-7.
• Background Bartz JA, Hollander E. The neuroscience of affiliation: forging links between basic and clinical research on neuropeptides and social behavior. Horm Behav. 2006 Nov;50(4):518-28. doi: 10.1016/j.yhbeh.2006.06.018. Epub 2006 Aug 1.
• Background Neumann ID. Involvement of the brain oxytocin system in stress coping: interactions with the hypothalamo-pituitary-adrenal axis. Prog Brain Res. 2002;139:147-62. doi: 10.1016/s0079-6123(02)39014-9.
• Background Carter CS, Altemus M. Integrative functions of lactational hormones in social behavior and stress management. Ann N Y Acad Sci. 1997 Jan 15;807:164-74. doi: 10.1111/j.1749-6632.1997.tb51918.x.
• Background Lightman SL, Young WS 3rd. Lactation inhibits stress-mediated secretion of corticosterone and oxytocin and hypothalamic accumulation of corticotropin-releasing factor and enkephalin messenger ribonucleic acids. Endocrinology. 1989 May;124(5):2358-64. doi: 10.1210/endo-124-5-2358.
• Background Neumann ID, Johnstone HA, Hatzinger M, Liebsch G, Shipston M, Russell JA, Landgraf R, Douglas AJ. Attenuated neuroendocrine responses to emotional and physical stressors in pregnant rats involve adenohypophysial changes. J Physiol. 1998 Apr 1;508 ( Pt 1)(Pt 1):289-300. doi: 10.1111/j.1469-7793.1998.289br.x.
• Background Stern JM, Goldman L, Levine S. Pituitary-adrenal responsiveness during lactation in rats. Neuroendocrinology. 1973;12(3):179-91. doi: 10.1159/000122167. No abstract available.
• Background Thoman EB, Conner RL, Levine S. Lactation suppresses adrenal corticosteroid activity and aggressiveness in rats. J Comp Physiol Psychol. 1970 Mar;70(3):364-9. doi: 10.1037/h0028710. No abstract available.
• Background Walker CD, Lightman SL, Steele MK, Dallman MF. Suckling is a persistent stimulus to the adrenocortical system of the rat. Endocrinology. 1992 Jan;130(1):115-25. doi: 10.1210/endo.130.1.1309321.
• Background Windle RJ, Wood S, Shanks N, Perks P, Conde GL, da Costa AP, Ingram CD, Lightman SL. Endocrine and behavioural responses to noise stress: comparison of virgin and lactating female rats during non-disrupted maternal activity. J Neuroendocrinol. 1997 Jun;9(6):407-14. doi: 10.1046/j.1365-2826.1997.00587.x.
• Background Uvnas-Moberg K. Oxytocin may mediate the benefits of positive social interaction and emotions. Psychoneuroendocrinology. 1998 Nov;23(8):819-35. doi: 10.1016/s0306-4530(98)00056-0.
• Background Uvnas-Moberg K, Ahlenius S, Hillegaart V, Alster P. High doses of oxytocin cause sedation and low doses cause an anxiolytic-like effect in male rats. Pharmacol Biochem Behav. 1994 Sep;49(1):101-6. doi: 10.1016/0091-3057(94)90462-6.
• Background Lundeberg T, Uvnas-Moberg K, Agren G, Bruzelius G. Anti-nociceptive effects of oxytocin in rats and mice. Neurosci Lett. 1994 Mar 28;170(1):153-7. doi: 10.1016/0304-3940(94)90262-3.
• Background Heinrichs M, Meinlschmidt G, Neumann I, Wagner S, Kirschbaum C, Ehlert U, Hellhammer DH. Effects of suckling on hypothalamic-pituitary-adrenal axis responses to psychosocial stress in postpartum lactating women. J Clin Endocrinol Metab. 2001 Oct;86(10):4798-804. doi: 10.1210/jcem.86.10.7919.
• Background Uvnas-Moberg K. Neuroendocrinology of the mother-child interaction. Trends Endocrinol Metab. 1996 May-Jun;7(4):126-31. doi: 10.1016/1043-2760(96)00036-7.
• Background Legros JJ, Chiodera P, Geenen V, Smitz S, von Frenckell R. Dose-response relationship between plasma oxytocin and cortisol and adrenocorticotropin concentrations during oxytocin infusion in normal men. J Clin Endocrinol Metab. 1984 Jan;58(1):105-9. doi: 10.1210/jcem-58-1-105.
• Background Legros JJ, Chiodera P, Demey-Ponsart E. Inhibitory influence of exogenous oxytocin on adrenocorticotropin secretion in normal human subjects. J Clin Endocrinol Metab. 1982 Dec;55(6):1035-9. doi: 10.1210/jcem-55-6-1035.
• Background Chiodera P, Coiro V. Oxytocin reduces metyrapone-induced ACTH secretion in human subjects. Brain Res. 1987 Sep 8;420(1):178-81. doi: 10.1016/0006-8993(87)90257-5.
• Background Suh BY, Liu JH, Rasmussen DD, Gibbs DM, Steinberg J, Yen SS. Role of oxytocin in the modulation of ACTH release in women. Neuroendocrinology. 1986;44(3):309-13. doi: 10.1159/000124661.
• Background House JS, Landis KR, Umberson D. Social relationships and health. Science. 1988 Jul 29;241(4865):540-5. doi: 10.1126/science.3399889.
• Background DeVries AC, Glasper ER, Detillion CE. Social modulation of stress responses. Physiol Behav. 2003 Aug;79(3):399-407. doi: 10.1016/s0031-9384(03)00152-5.
• Background Henry JP, Wang S. Effects of early stress on adult affiliative behavior. Psychoneuroendocrinology. 1998 Nov;23(8):863-75. doi: 10.1016/s0306-4530(98)00058-4.
• Background Insel TR, Young LJ. The neurobiology of attachment. Nat Rev Neurosci. 2001 Feb;2(2):129-36. doi: 10.1038/35053579.
• Background Heinrichs M, Baumgartner T, Kirschbaum C, Ehlert U. Social support and oxytocin interact to suppress cortisol and subjective responses to psychosocial stress. Biol Psychiatry. 2003 Dec 15;54(12):1389-98. doi: 10.1016/s0006-3223(03)00465-7.
• Background Winslow JT, Noble PL, Lyons CK, Sterk SM, Insel TR. Rearing effects on cerebrospinal fluid oxytocin concentration and social buffering in rhesus monkeys. Neuropsychopharmacology. 2003 May;28(5):910-8. doi: 10.1038/sj.npp.1300128. Epub 2003 Mar 26.
• Background Kosfeld M, Heinrichs M, Zak PJ, Fischbacher U, Fehr E. Oxytocin increases trust in humans. Nature. 2005 Jun 2;435(7042):673-6. doi: 10.1038/nature03701.
• Background Kirsch P, Esslinger C, Chen Q, Mier D, Lis S, Siddhanti S, Gruppe H, Mattay VS, Gallhofer B, Meyer-Lindenberg A. Oxytocin modulates neural circuitry for social cognition and fear in humans. J Neurosci. 2005 Dec 7;25(49):11489-93. doi: 10.1523/JNEUROSCI.3984-05.2005.
• Background Breslau N, Chilcoat HD, Kessler RC, Davis GC. Previous exposure to trauma and PTSD effects of subsequent trauma: results from the Detroit Area Survey of Trauma. Am J Psychiatry. 1999 Jun;156(6):902-7. doi: 10.1176/ajp.156.6.902.
• Background Keane TM, Gerardi RJ, Lyons JA, Wolfe J. The interrelationship of substance abuse and posttraumatic stress disorder. Epidemiological and clinical considerations. Recent Dev Alcohol. 1988;6:27-48. doi: 10.1007/978-1-4615-7718-8_2.
• Background Schumm JA, Briggs-Phillips M, Hobfoll SE. Cumulative interpersonal traumas and social support as risk and resiliency factors in predicting PTSD and depression among inner-city women. J Trauma Stress. 2006 Dec;19(6):825-36. doi: 10.1002/jts.20159.
• Background Yehuda R. Biological factors associated with susceptibility to posttraumatic stress disorder. Can J Psychiatry. 1999 Feb;44(1):34-9. doi: 10.1177/070674379904400104.
• Bertolini F, Robertson L, Bisson JI, Meader N, Churchill R, Ostuzzi G, Stein DJ, Williams T, Barbui C. Early pharmacological interventions for prevention of post-traumatic stress disorder (PTSD) in individuals experiencing acute traumatic stress symptoms. Cochrane Database Syst Rev. 2024 May 20;5(5):CD013613. doi: 10.1002/14651858.CD013613.pub2.
• Bertolini F, Robertson L, Bisson JI, Meader N, Churchill R, Ostuzzi G, Stein DJ, Williams T, Barbui C. Early pharmacological interventions for universal prevention of post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2022 Feb 10;2(2):CD013443. doi: 10.1002/14651858.CD013443.pub2.

Drugs

Indications