Anesthesia and the neurobiology of fear and posttraumatic stress disorder

Abstract

Purpose of reviewDysfunction of fear memory systems underlie a cluster of clinically important and highly prevalent psychological morbidities seen in perioperative and critical care patients, most archetypally posttraumatic stress disorder (PTSD). Several sedative-hypnotics and analgesics are known to modulate fear systems, and it is theoretically plausible that clinical decisions of the anesthesiologist could impact psychological outcomes. This review aims to provide a focused synthesis of relevant literature from multiple fields of research.Recent findingsThere is evidence in some contexts that unconscious fear memory systems are less sensitive to anesthetics than are conscious memory systems. Opiates may suppress the activation of fear systems and have benefit in the prevention of PTSD following trauma. There is inconsistent evidence that the use of propofol and benzodiazepines for sedation following trauma may potentiate the development of PTSD relative to other drugs. The benefits of ketamine seen in the treatment of major depression are not clearly replicated in PTSD-cluster psychopathologies, and its effects on fear processes are complex.SummaryThere are multiple theoretical mechanisms by which anesthetic drugs can modulate fear systems and clinically important fear-based psychopathologies. The current state of research provides some evidence to support further hypothesis investigation. However, the absence of effectiveness studies and the inconsistent signals from smaller studies provide insufficient evidence to currently offer firm clinical guidance.

Personalized repetitive transcranial magnetic stimulation (prtms®) for post-traumatic stress disorder (ptsd) in military combat veterans

“…Both may be implicated [ 39 ] in PTSD's “core component” of implicit memories [ [40] , [41] , [42] ] contained within the re-experiencing “B” diagnostic criteria along with the automatic [ 43 ] “negative alterations in cognitions” [ 44 , 45 ] that are encoded within in “D” diagnostic criteria e.g., negative thoughts and assumptions [ 12 ]. Furthermore, implicit trauma-related cues [ 46 , 47 ], and irrational [ 48 , 49 ] decision making may worsen PTSD symptoms [ 12 ] while psychotherapeutic and psychopharmacologic therapeutic approaches targeting automatic processing [ [50] , [51] , [52] ] namely, Eye Movement Desensitization and Reprocessing [ 53 ] or psychedelics [ 54 ] seem to exert beneficial effect for PTSD patients.…”

Addressing Parental Stress and Reducing Avoidable Benzodiazepine Exposure in Children During Hospitalization in Pediatric Intensive Care Units to Improve Mental Health Outcomes

“…BZDs are widely used in sedative, co-analgesic or antiepileptic indications but also in the treatment of anxiety. Even with limited evidence, it is possible that BZDs potentiate the development of PTSD in the aftermath of traumatic exposure by modulating fear systems and memory mechanism [4]. This underlines our need, and somewhat urgency, to include treatment of mild to moderate anxiety in PICU, by promoting early education, information, support, cognitive behavioral therapy (CBT), other medication-free ways of treating anxiety or alternative medications to BZD.…”