Thesis Paper

Introduction

Post Traumatic Stress Disorder (PTSD) diagnosis is often the outcome of exposure to an

overwhelming stressful event or series of events, such as military combat, rape, or abuse and is a

normal response by normal people to an abnormal situation (Schiraldi, 2009). It is estimated that

more than 80% of adults in the United States experience traumatic events that would qualify for

acute stress disorder (ASD) or PTSD diagnosis and 7 or 8 out of every 100 people will have

PTSD at some point in their lives (Breslau, 2012; National Center for PTSD, 2016). The annual

cost to society of anxiety disorders is estimated to exceed well over $42.3 billion due to

psychiatric and non-psychiatric medical treatment costs, indirect workplace costs, mortality

costs, and prescription drug costs (PTSD United, 2013). It is without question one of the largest

public health concerns to date.

Tertiary treatment options such as cognitive behavioral therapy (CBT), eye movement

desensitization and reprocessing (EMDR), virtual-reality exposure therapy (VRET), group

therapy (GT), and many other palliative treatment options accompanied with selective serotonin

reuptake inhibitors (SSRIs) have been the subject of numerous studies discussed in hundreds of

scholarly comprehensive reviews (National Center for PTSD, 2016; Howlett & Stein, 2015).

Common risk factors among PTSD sufferers that have been associated with tertiary treatment

options include: Living through dangerous events and traumas, getting hurt, seeing another

person hurt, seeing a dead body, childhood trauma, having little or no social support after a

traumatic event, and having a history of mental illness or substance abuse (National Institutes of

Mental Health [NIH], 2016). Identifying these at risk populations accompanied with primary

and secondary preventative measures should hypothetically drastically decrease occurrence of

PTSD. Somatic pharmacologic interventions may be the most viable pre-treatment and pre-

symptomatic options for these at risk populations.

PTSD and ASD according to the Diagnostic and Statistical Manual of Mental Disorders

(DSM-5) are classified as a trauma and stressor related disorder (American Psychiatric

Association, 2013). The most widely used structured clinical interviews for diagnosing PTSD is

the clinician-administered PTSD scale or (CAPS) (American Psychiatric Association, 2013;

Frijiling, et. al., 2014). Researchers and Clinicians agree that trauma is a precursor to a PTSD

diagnosis, knowing this pharmacologic research to develop interventions has significantly

increased; however, regardless of progress, clinical evidence for preventive interventions is

alarmingly underdeveloped (Stein & Lang, 2013). Clinicians may one day find themselves in a

position to prevent these disorders through primary and secondary somatic pharmacologic

approaches. Until then greater efforts to influence preclinical and clinical models to expand and

test new pharmacologic prevention strategies are desperately required.

Purpose Statement

This systematic review will examine and build a case for the potential efficacy of somatic

pharmacologic cases related to pre-trauma (primary) and pre-symptomatic (secondary)

hypothesized PTSD interventions. The primary purpose of this review is to highlight the

importance of continued research and funding into hypothetically known and unknown pre-

trauma and pre-symptomatic somatic pharmacologic PTSD interventions.

Research Questions

1. What primary preclinical somatic pharmacologic interventions are being hypothesized as

possible PTSD inhibitors?

2. What secondary preclinical somatic pharmacologic interventions are being hypothesized

as possible PTSD inhibitors?

3. What types of preclinical case studies have been performed with primary and secondary

hypothesized somatic pharmacologic PTSD interventions?

4. Who are the stakeholders in support of continued research into hypothesized preventative

somatic pharmacologic PTSD interventions?

5. Is there a case for efficacy to administer hypothetical preventative somatic pharmacologic

PTSD inhibitors in clinical trials?

Definitions of Terms

1. Efficacy - the ability to produce a desired or intended result

2. Pharmacologic - relating to the branch of medicine concerned with the uses, effects, and

modes of action of drugs

3. Preclinical - relating to or denoting a stage preceding a clinical stage, in particular

4. Primary prevention - enhancing resistance to the effects of exposure to a disease agent

5. Secondary prevention - slowing the progression of a disease or its sequelae at any point

after its inception

6. Somatic - relating to the body, especially as distinct from the mind