A steroid injection given shortly after a traumatic event could reduce the risk that the victim will later develop post-traumatic stress disorder, a new study suggests.
In the study, which involved 17 trauma patients, those who received injections of the steroid hormone cortisol within six hours of their injury were significantly less likely than those not given injections to develop PTSD several months later, the researchers said.
The findings suggest there may be a “window of opportunity” immediately following a trauma during which action can be taken to prevent PTSD, said the researchers, who are now conducting a wider study.
“One can think about it as the morning-after pill for PTSD,” said study researcher Joseph Zohar of Tel Aviv University in Israel. Doctors call such precautions that are taken after the fact, such as the contraceptive pill ingested after sex, “secondary prevention.”
If the findings are confirmed, “this will be the first time that there is secondary prevention in psychiatry,” Zohar said.
The study will be published in the October issue of the journal European Neuropsychopharmacology.
PTSD and cortisol
When people experience stress or anxiety, the body responds by releasing stress hormones, including cortisol. In the new study, Zohar and colleagues tried to mimic the natural response of the body by administering hydrocortisone, the pharmaceutical form of cortisol.
The study involved patients who visited an emergency department after traumatic events, including car crashes and work-related accidents. Participants were randomly assigned to receive a single shot of hydrocortisone or a placebo.
After three months, three of the eight patients in the placebo group were diagnosed with PTSD. After one month, one person who received hydrocortisone showed signs PTSD, and after three months, no one in the hydrocortisone group did.
If larger studies confirm the injections effectiveness, “you could theoretically have a treatment that would markedly help reduce the emergence of post traumatic stress disorder in trauma victims,” said Dr. Charles Nemeroff, professor and chairman of psychiatry at the University of Miami Miller School of Medicine, who was not involved in the study.
Quite a few patients treated with hydrocortisone dropped out of the study before the one month and three month mark, and it would be important to know whether leaving had anything to do with the treatment or their current mental states, Nemeroff said.
Preventing bad memories
Because the participants in the study had been in accidents of everyday life, it's unclear whether a shot of hydrocortisone would have the same effect on someone who experienced a different type of trauma, such as one related to combat, Zohar said.
It's possible people who are predisposed to PTSD have abnormalities in the way their brains release cortisol, Zohar said. By injecting hydrocortisone, the researches may be augmenting the stress response and thus helping to prevent PTSD.
Cortisol also may act to prevent the formation of memories, Zohar said.
For people with PTSD, “the past is always present,” Zohar said. “The individuals are haunted by their traumatic experience.” Administering cortisol might prevent PTSD by not allowing the complete formation of memories of a traumatic event.
Zohar said he and his colleagues are now carrying out a larger trial using hydrocortisone on trauma victims.
Pass it on: A single shot of hydrocortisone may prevent the development of PTSD in trauma victims.
Editor's note: This article was updated on Oct. 6 to include statements from Dr. Charles Nemeroff.
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