Abstract

Objective: Posttraumatic Stress Disorder (PTSD) and opioid withdrawal are both associated with increased activation of the sympathetic nervous system. Transcutaneous cervical vagus nerve stimulation (tcVNS) reduces sympathetic function and inflammation and therefore has the potential to help patients with PTSD or Opioid Use Disorder (OUD).

Methods: Patients with PTSD and those with OUD undergoing acute opioid withdrawal were randomly assigned to receive double blind active tcVNS or sham stimulation with exposure to personalized traumatic scripts or opioid cue videos. PTSD patients underwent three months of tcVNS or sham stimulation twice daily and monthly in conjunction with a paragraph memory encoding task.

Results: tcVNS compared to sham resulted in significant reductions in sympathetic function measured with pre-ejection period (PEP) in PTSD (p<.05) and subjective opioid withdrawal (p = .047), pain (p = .045), and distress (p = .004) in OUD patients and enhanced medial prefrontal brain function in both groups. Paired tcVNS with memory encoding resulted in a 99% increase in memory recall over three months not seen with sham stimulation.

Conclusions: tcVNS reduces behavioral and physiological manifestations of PTSD and opioid withdrawal and has positive effects on cognition and memory.

Biography

J. Douglas Bremner, M.D., is Professor of Psychiatry and Radiology and Director of the Emory Clinical Neuroscience Research Unit (ECNRU) at Emory University School of Medicine in Atlanta Georgia and Staff Psychiatrist at the Atlanta VA Medical Center in Decatur, Georgia. In 2000-2006 he was Director of the Emory Center for Positron Emission Tomography (PET). Dr. Bremner moved to Emory from Yale in November of 2000 where he spent the first 12 years of his career.

Dr. Bremner’s research has used neuroimaging and neurobiology measures to study the neural correlates and neurobiology of posttraumatic stress disorder (PTSD) related to combat and childhood abuse, as well as the related areas of depression and opioid use disorder (OUD). His more recent work is expanding to look at the relationship between brain, behavior, and physical health including studies of neurobiological mechanisms involved in the relationships between stress and depression and cardiovascular disease, as well as the effects of different treatments for stress-related conditions on the brain. His research included studies of the neurobiology and assessment of PTSD, hippocampus and memory in PTSD and depression, neural correlates of declarative memory and traumatic remembrance in PTSD, PET measurement of neuroreceptor binding in mood and anxiety disorders, neurobiological and cardiovascular correlates of stress-induced myocardial ischemia, and the effects of psychotropic drugs and behavioral interventions like meditation on brain function and structure. His studies using magnetic resonance imaging (MRI) to show smaller hippocampal volume in PTSD and depression are amongst the most highly cited in the field. He also wrote and developed and validated several behavioral measures that have been widely translated and used, including the Early Trauma Inventory (ETI) and the Clinician Administered States Scale (CADSS). Research on the effects of non-invasive Vagal Nerve Stimulation (nVNS) in stress-related psychiatric disorders led to Food and Drug Administration (FDA) Breakthrough Device Designation for PTSD based on his research in 2022, and this work has expanded to OUD and cognitive disorders.

Bremner has worked continuously throughout his career as a physician scientist, with the support of funding from two successive Veterans Administration (VA) Career Development Awards and two National Institute of Health (NIH) K24 Awards, VA Merit Review, NIH, Defense Advanced Projects Agency (DARPA), Department of Defense (DOD), and various private sources.

Following obtaining a bachelors degree in literature, Dr. Bremner attended medical school at Duke University where he graduated in 1987, followed by residency in Psychiatry (1991) and Nuclear Medicine (1997) at Yale School of Medicine, leading to a double board certification. Bremner was a VA Biological Psychiatry Fellow at the West Haven VA and Yale from 1990-1993, Assistant and Associate Professor of Psychiatry and Radiology from 1993 to 2000, Director of the Yale Trauma Research Program and Associate Director of the Yale PET Center, before moving to Emory in 2000 to take his current position.

Dr. Bremner has written over 400 articles in scientific journals, edited three books, written six books and contributed multiple book chapters for edited volumes in the field.

Students registered for the seminar are expected to attend in person.

Teams ID and Passcode:

Meeting ID: 211 123 896 292 8

Passcode: Uh9qs2pf