Raza Sagarwala1, Henry A Nasrallah. 1. Saint Louis University School, of Medicine, St. Louis, MO USA. E-MAIL: raza.sagarwala@health.slu.edu.
Abstract
BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) are regarded as the standard pharmacotherapy for the treatment of posttraumatic stress disorder (PTSD). Recent studies indicate that neuroinflammation is associated with PTSD. We conducted a search of the literature to determine if SSRI efficacy is associated with a decrease in inflammation levels. METHODS: A literature search was conducted to identify studies published from January 2000 to January 2019 that measured changes in inflammatory biomarkers before and after SSRI treatment in patients with PTSD. RESULTS: Four studies met the criteria for inclusion. In one study, SSRI use significantly reduced interleukein-1beta. An open trial of paroxetine found a significant decline in cortisol. In a third study, paroxetine treatment in patients with PTSD and depression showed no significant changes in cortisol. Finally, analysis of cerebrospinal fluid in patients with PTSD showed no significant changes in corticotropin-releasing factor, interleukin-6, brain-derived neurotrophic factor, or insulin-like growth factor 1. Substance P was found to be decreased. CONCLUSIONS: Our review had mixed results regarding whether SSRI therapy for PTSD is associated with a reduction in inflammation. These findings may be due to the heterogeneity of PTSD. More randomized controlled trials are needed due to the potential benefits of SSRIs for reducing inflammation in patients with PTSD (as has been reported in depression studies).
BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) are regarded as the standard pharmacotherapy for the treatment of posttraumatic stress disorder (PTSD). Recent studies indicate that neuroinflammation is associated with PTSD. We conducted a search of the literature to determine if SSRI efficacy is associated with a decrease in inflammation levels. METHODS: A literature search was conducted to identify studies published from January 2000 to January 2019 that measured changes in inflammatory biomarkers before and after SSRI treatment in patients with PTSD. RESULTS: Four studies met the criteria for inclusion. In one study, SSRI use significantly reduced interleukein-1beta. An open trial of paroxetine found a significant decline in cortisol. In a third study, paroxetine treatment in patients with PTSD and depression showed no significant changes in cortisol. Finally, analysis of cerebrospinal fluid in patients with PTSD showed no significant changes in corticotropin-releasing factor, interleukin-6, brain-derived neurotrophic factor, or insulin-like growth factor 1. Substance P was found to be decreased. CONCLUSIONS: Our review had mixed results regarding whether SSRI therapy for PTSD is associated with a reduction in inflammation. These findings may be due to the heterogeneity of PTSD. More randomized controlled trials are needed due to the potential benefits of SSRIs for reducing inflammation in patients with PTSD (as has been reported in depression studies).