Intranasal Oxytocin to Prevent Posttraumatic Stress Disorder Symptoms: A Randomized Controlled Trial in Emergency Department Patients

Abstract

Oxytocin administration early after trauma did not attenuate clinician-rated PTSD symptoms in all trauma-exposed participants with acute distress. However, participants with high acute clinician-rated PTSD symptom severity did show beneficial effects of oxytocin. Although replication is warranted, these findings suggest that oxytocin administration is a promising preventive intervention for PTSD for individuals with high acute PTSD symptoms.

Intensive Care Unit Delirium and Intensive Care Unit–Related Posttraumatic Stress Disorder

“…Evidence from studies in animals and in healthy and psychiatric human populations have shown that oxytocin administration may modulate glucocorticoid and autonomic stress reactivity (100, 101), dampen anxiety, and alter neural threat processing (102, 103). However after exposure to trauma, oxytocin administration showed detrimental effects increasing amygdala reactivity to fearful faces and decreasing amygdala-ventrolateral prefrontal functional connectivity (104). Moreover other studies indicate that the effects of a single oxytocin administration may differ from the effects of repeated administration; the latter may be required to achieve clinically relevant effects regarding the prevention of PTSD (104).…”

Trauma Disclosure Moderates the Effects of Oxytocin on Intrusions and Neural Responses to Fear

“…Neuroendocrinological targets include the hypothalamic peptide oxytocin (OXT). Currently, there is conflicting evidence whether or not early posttrauma administration of OXT could be effective in reducing PTSD-like symptoms in victims of recent traumatic experiences [3]. Furthermore, it is increasingly recognized that the prosocial and anxiolytic effects of intranasal OXT are moderated by context factors [4].…”

Application of data pooling to longitudinal studies of early post-traumatic stress disorder (PTSD): the International Consortium to Predict PTSD (ICPP) project

“…a minimum score on a screening instrument). For example, three studies (Bryant et al, 2012; deRoon-Cassini et al, 2010; Jenewein et al, 2009) had a minimum hospital admission length (24–48 hours), and three studies (Bonne et al, 2001; Shalev et al, 2012; van Zuiden et al, 2017) had a minimum threshold or criterion for initial symptoms. These criteria screened for more severely injured or more symptomatic patients to be included in the studies.…”

“…The Jerusalem Trauma Outreach and Prevention Study (JTOPS) had 296 out of 1996 participants randomly assigned to treatment groups that included cognitive behavioural therapy, escitalopram, and placebo (Shalev et al, 2012). The Amsterdam oxytocin study (van Zuiden et al, 2017) evaluated the preventive effect of oxytocin, and data included in the ICPP consisted of that study’s placebo group. Beyond available information regarding general study design, investigators have used various inclusion and exclusion criteria for recruitment (Appendix 1).…”

“…The International Consortium to Predict PTSD (ICPP) is an effort sponsored by the US National Institute of Mental Health to create a consortium of principal investigators of published and unpublished longitudinal PTSD studies (Bonne et al, 2001; Bryant, Creamer, O’Donnell, Silove, & McFarlane, 2008; deRoon-Cassini, Mancini, Rusch, & Bonanno, 2010; Hepp et al, 2008; Irish et al, 2008; Jenewein, Wittmann, Moergeli, Creutzig, & Schnyder, 2009; Matsuoka et al, 2009a; Mouthaan et al, 2014; Shalev et al, 2012, 2000, 2008; van Zuiden et al, 2017), combine their individual- and item-level data towards carrying out a pooled secondary analysis, and synthesize information about the predictors of PTSD. The ICPP’s goal is to pool and harmonize extant data sets so as to inform PTSD pathogenesis and prediction across trauma types, severity, geography, and clinical circumstances.…”