Ralph H. Johnson VA Medical Center
PTSD study to help future Veterans find balance
What do a psychiatrist and an immunologist have in common? At the Ralph H. Johnson VA Medical Center, they share an interest in finding better ways to treat Veterans with PTSD. That common goal is what turned a chance meeting in the hallway between Charleston VA psychiatrist Dr. Zhewu Wang and immunologist Dr. Rita Young into a robust research collaboration between two seemingly disparate disciplines. This spring, the Department of Veterans Affairs awarded their research team with a grant to explore the effects of posttraumatic stress disorder on the immune system, and how understanding this interaction can lead to effective treatment.
An alarming number of combat Veterans return from duty expecting to leave the travails of war behind, only to discover that posttraumatic stress can impact their life long after they’ve left the battlefield. More than 2.5 million U.S. Servicemembers have been deployed to the Afghanistan or Iraq war zones since 2002, and according to VA reports, one in every six of them returns with PTSD.
PTSD is especially pronounced among OEF/OIF Veterans; among those enrolled in VA health care, 24.7 percent are diagnosed with PTSD. As they deal with a range of symptoms from agitation and irritability, experiencing flashbacks and severe anxiety, and harboring feelings of guilt and loneliness, these Veterans quickly discover that the disorder has the potential to derail their new life as a civilian. Many also find they’ve lost interest in activities they once found relaxing or pleasurable.
Dr. Wang works to help Veterans manage their symptoms and deal with the psychological stressors that affect their everyday life. He is part of Charleston VA’s intake team, assessing newly enrolled Veterans for PTSD. Yet even as Wang and other practitioners across the VA work diligently to provide the best mental health services to these returning troops, research shows that only about half of combat Veterans respond to PTSD treatments, placing them at risk for chronic illness and poor outcomes. Finding better courses of treatment for these Veterans has been a driving factor for Wang’s PTSD research.
Where psychiatry meets immunology
In addition to dealing with the behavioral, psychological, and emotional impact of posttraumatic stress, studies – including research conducted here at Charleston VA – show a strong association between PTSD diagnosis and immune function. The immune system is the body’s defense mechanism against diseases, infections, and invading organisms and microbes. The mechanisms underlying PTSD are unclear, but immunological contributions to PTSD following trauma, like those that combat Veterans face in a warzone, have been suggested. Additionally, other studies have shown a higher incidence of autoimmune disorders among PTSD patients, which supports the link between this disorder and immune function.
That’s where Charleston VA immunologist Dr. Rita Young enters the equation. Dr. Young has a long career of studying the interactions between disease states and immunologic functions. Her recent work with Dr. Wang demonstrates the link between stimulatory immunological responses in Veteran with PTSD. Cytokines, or mediators, work similarly in the body to the way hormones do; they communicate between immune cells and other cells in the body, e.g. brain cells. Most individuals’ immune systems are regulated by two types of mediators: 1) stimulatory mediators, which effectively “turn on” one’s immune system, and 2) inhibitory mediators, which turn it off.
When compared with individuals without PTSD, PTSD patients have been shown to have higher levels of stimulatory immune mediators that have the ability to stimulate brain cell inflammation. Stimulatory mediators have been associated with the release of stress hormones, and behavioral characteristics, such as agitation and irritability. Young’s observations of blood and saliva samples from Veterans with PTSD have shown an increase in stimulatory mediators, which prevents inhibitory functions.
The way forward
Young and Wang hypothesize that there is an immune imbalance toward inflammatory mediators in patients with PTSD, and they will determine if the imbalance is associated with PTSD severity. Additionally, the researchers seek to determine how the immune cells affect brain cells, and if the immune-brain communication can be redirected in the lab from a hyper-inflammatory state to a more regulated one.
Psychiatry and immunology may seem to make an unlikely pair, but the expertise of both disciplines is essential to build the foundation for a new way to treat a syndrome that affects so many of our country’s heroes. Wang’s psychological assessments of OEF/OIF combat Veterans and Young’s immunological analyses are laying the groundwork for targeted pharmacological interventions, which is consistent with the VA’s overall goal to improve Veteran health and well-being by developing novel treatment of health issues that are unique to Veterans.
Interested OEF/OIF Veterans who were exposed to combat can get more information about study participation by calling 843-789-7120. Veterans do not need to have a PTSD diagnosis to participate in this research.