This is the holy grail for brain imaging,” says lead researcher Dr. K. Luan Phan, chief of neuropsychiatric research at the Jesse Brown Veterans Affairs Medical Center and professor of psychiatry at the University of Illinois at Chicago. “We hope in the future to be able to use scans to help distinguish PTSD from other illnesses, and then to predict how well someone will do with a certain medication, or with talk therapy. What we envision is being able to say to a patient, ‘Given your scan value, you have an X percent chance of getting better on this treatment.'”
The approach, says Phan, will benefit patients and providers alike: “We’ll be saving a lot of resources on the clinical side, and more importantly, we’ll also not be wasting patients’ time sending them for a treatment that is not likely to help them.”
His latest study included 34 Iraq and Afghanistan veterans, half of them with PTSD. They all got functional MRI scans, which track blood flow in the brain to show which areas are using the most oxygen–a sign of increased activity.
The researchers saw that among the PTSD group, who were all taking the drug paroxetine (sold as Paxil), the patients who showed the most improvement from the SSRI were those who showed the least activation, prior to treatment, of a brain area called the right ventrolateral prefrontal cortex, also known as the inferior frontal gyrus. The region is known to help with emotional regulation. It serves as a rational counterbalance to parts of the brain that generate raw emotion. It helps with tasks like impulse control, cognitive flexibility, and executive function. “These are all ingredients of emotional regulation,” says Phan.