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Jun 25, 2006 6:30 pm US/Pacific
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Memory Pill
(CBS 5)
"I have nightmares every night, I literally do," says Marine Sergeant A.P. Apineru.
Like thousands of soldiers wounded in Iraq, Sgt. Apineru can tell you about the images that keep resurfacing in his memory. But unlike most, he can show them to you as well.
"This is it coming," he says, as he stares intently at his laptop computer.
The grainy video, posted on the internet by insurgents captures the exact moment they blew up the truck Apineru and his fellow Marines were riding in. He says, watching the explosion is a like a window, into his nightmares. While doctors at the Veteran's Administration Hospital in Palo Alto have managed to repair much of Apineru's body, he says therapists have yet to reach the damage in his mind.
We asked him what it's like to experience an episode of post-traumatic stress disorder.
"The scariest part is that somebody's trying to kill you."
But why does Apineru think his brain remembers the bad stuff from Iraq so vividly? "I keep asking myself every time," he says, "I guess that's because of the incident. Because I remember fighting for my life."
As it turns out, he may be right.
In the last few years, researchers have begun to dig at the biological roots of post-traumatic stress disorder. Why the brain stores some memories differently than others. What they've learned could for the first time lead to a way to manipulate those memories. Manipulate them with a pill.
Researchers are focusing on two drugs, propranolol and D-cycloserine, which work on the brain in different ways to target specific traumatic memories.
To do that researchers first had to understand how those memories are formed. They say intense fear can cause our bodies to send stress hormones like adrenaline flooding into the emotional centers of the brain. In extreme cases, that causes an area called the amygdala to go into overdrive, storing the memory with a survival of the species intensity.
"So we view this as an evolutionary boost system," says Larry Cahill a researcher with U.C. Irvine, "that under the wrong situation can get cranked up and produce post traumatic stress disorder."
Cahill, and his colleague James McGaugh wanted to know if the propranolol, which blocks signals sent out by the amygdala, could prevent that cranking-up from happening.
In a landmark study, they showed test subjects a series of photos, some extremely disturbing. After viewing the slide show, half the people were given propranolol while the other half received no drug at all. When tested a week later, the group without the drug vividly remembered the disturbing images while the propranolol group did not.
"What the evidence says we're doing is preventing memory from becoming hyper-strong, and then becoming a cornerstone of post-traumatic stress disorder," says Cahill.
The possibilities soon captured the imagination of researchers across the country. Could propranolol work like an inoculation against post-traumatic stress disorder? Could someone have given Apineru a pill, as he lay next to the shattered wreckage of that truck, to protect him from developing a reoccurring memory?
To test the theory, Dr. Charles Marmar, Director of Psychiatry at the V.A. Medical Center in San Francisco gave the drug to accident victims as they were being treated in hospital emergency rooms. In follow-up interviews, victims showed a remarkable lack of stress as they recalled their accidents.
"The more quickly a trauma victim can calm down, the less likely they are to be afraid of the reminders of the trauma. And the less likely they are to be troubled by searing repeated memories of the trauma," says Marmar.
But despite the promise of treating victims of everything from car accidents to sexual assault, just the idea of tinkering with a memory at its source has alarmed some critics.
"We're opening a pandora's box," argues David Magnus of the bioethics department at Stanford University.
"So we could be facing a world where when people go through that period when you say, Oh I wish I hadn't done that last night, or we go through a painful breakup, or I embarrass myself last night, and I can't go to work on Monday, you'll see people starting to take these pills for that reason."
But if the treatment's potential conjures up Hollywood images of an instant memory eraser, like the little flash stick wielded by actor Tommy Lee Jones in the movie Men in Black, researchers counter it's not the memory they're trying to erase at all, but the emotional reaction it triggers.
"There's nothing that makes us think that giving this drug is like boom, an eraser on a white board," says Cahill. "I wish had that kind of power like Bones on Star Trek and go up and hit rewind and the memory's gone."
While the debate continues over the memory-morphing potential of Propranolol, work is also advancing quickly with that second drug we told you about, D-cycloserine. Instead of affecting the way our brains remember trauma, it helps us forget.
"In post-traumatic stress disorder, what they're scared of is the memory," says Dr. Barbara Rothbaum of Emory University. She says the first step in overcoming the memories, is to get veterans to confront them openly.
To help them do that Rothbaum plans to immerse veterans in a 'virtual Iraq,' a computer generated environment so real, its designed to trigger their worst memories.
Then she administers a light dose of D-cycloserine which she believes strengthens the logical part of the human brain in the frontal lobe, which normally re-extinguishes traumatic memories over time, by slowly learning to reinterpret them.
"And by exposing veterans over and over they have a chance to decrease anxiety," says Rothbaum.
In earlier trials with people suffering from fear of heights, patients were able to conquer their fear in a fraction of the normal time, using the combination of a virtual reality exposure and D-cycloserine.
Rothbaum believes giving soldiers like Apineru the same therapy could allow them to leave the battlefield behind and finally come home.
"We don't want to make the same mistakes from Vietnam," she says, referring to the thousands of cases of post-traumatic stress disorder that went untreated for decades.
"Yeah, I would love to try that," says Apineru. about the potential treatment that could help with his reoccurring flashbacks and nightmares.
"It is scary, I'm not going to sit here and lie about it. I do cry sometimes. It's stuck for me, I can't get rid of it."
Soon, Apineru and other Bay Area veterans may have a chance to participate in the research.
Dr. Charles Marmar is currently recruiting local veterans of either Iraq or Afghanistan for trials using D-cycloserine, which he now believes offers more promise for treating post-traumatic stress disorder than propranolol, which he tested in 2003.
"We're particularly interested to determine if combination of cognitive behavioral therapy with use of D-cycloserine in low dose, administered a half-hour before the therapy session would lesson the number of treatment sessions required, and even result in longer lasting treatment results, he says."
The study is being coordinated though the Veteran's Hospital at Ft. Miley in San Francisco.
Interested veterans can call (888) 567-6337, or click visit
www.ptsdresearch.net for more information on the post-traumatic stress disorder study at the San Francisco V.A. Hospital.
(© MMVI, CBS Broadcasting Inc. All Rights Reserved.)