:: Volume 8, Issue 1 (Winter - 2019) ::
Shefaye Khatam 2019, 8(1): 51-62 Back to browse issues page
Comparison of the Effectiveness of Sertraline, Transcranial Direct Stimulation Current and their Combination on Post-Traumatic Stress Disorder in Veterans
Shabnam Sarhadi, Fatemeh Ghaemi *, Fariborz Dortaj, Ali Delavar
Ministry of Health and Medical Education, Deputy of Health, Tehran, Iran , ghaemifatemeh@yahoo.com
Abstract:   (1003 Views)
Introduction: Traumatic Stress Disorder (PTSD) is one of the most prevalent health problems in the victims of the Iran-Iraq war. Despite many advantages of the administration of selective serotonin reuptake inhibitors, as the first-line treatment of PTSD, a large number of the patients still need more effective therapies. The purpose of this study was to comparison of the effectiveness of sertraline, transcranial direct stimulation current (TDCS), and the combined treatment (TDCS and sertraline) to relieve the symptoms of PTSD in the veterans in Tehran, Iran. Materials and Methods: The current study was a semi-experimental study including pre- and post-tests, a control group, and three-month follow-up. The population of study was veterans who lived in Tehran in 2018. 68 veterans were selected by purposive sampling method and then randomly divided to control and experimental groups. The first group was treated with sertraline, the second group received TDCS, and the third group treated with the combined treatment. The PTSD Checklist for DSM-5(PCL-5) was used as a research tool. Results: All of the treatment approaches were effective in reduction of symptoms in patients with PTSD. In the post-test and follow-up phase, there was a significant difference in PCL-5 scores between sertraline, TDCS, and combined treatment in comparison with the control group. Combined treatment (TDCS and sertraline) have shown a significantly higher and persistence effectiveness. Conclusion: Combined treatment with TDCS and sertraline can be used as an efficient and effective approach to reduce PTSD symptoms in veterans.
Keywords: Transcranial Direct Current Stimulation, Sertraline, Veterans, Combat Disorders
Full-Text [PDF 1147 kb]   (284 Downloads)    
Type of Study: Research --- Open Access, CC-BY-NC | Subject: Basic research in Neuroscience
1. Moradi A, Salimi M, Fathi-Ashtiani A. Memory performance among Iranian veterans with posttraumatic stress disorder. Journal of Behavioral Sciences. 2011; 4(4): 269-76.
2. Pourabaian-Esfahani MH, Esmaeili L, Dabbashi F, Amini M. The effectiveness of music therapy on general health of veterans with post-traumatic stress disorder (P.T.S.D). Knowledge & Research in Applied Psychology. 2016; 17(4): 41-9.
3. Oraki M, Faraji R, Zarei H, Nejati V. The effectiveness of transcranial direct current stimulation (TDCS) on executive functions of war survivors who suffer from PTSD. Neuropsychology. 2018; 3(4): 103-14.
4. Sadeghi M, Taghva A, Goudarzi N, Rah-Nejat AM. Validity and reliability of persian version of "post-traumatic stress disorder scale" in war veterans. Iranian Journal of War & Public Health. 2016; 8(4): 243-9.
5. Mandani B, Fakhri A. Study f health related quality of life in posttraumatic stress disorder war veterans. Iranian Journal of War & Public Health. 2013; 5(2): 18-25.
6. Sadock, BJ, Sadock VA, Ruiz P. Kaplan & shaddock's synopsis of psychiatry. Behavioral Science. 11th ed. Tehran. Arjmand Press. 2015; P. 783-7.
7. Shalev A, Liberzon I, Marmar C. Post- traumatic stress disorder. N Engl J med. 2017; 376(25): 2459-69. [DOI:10.1056/NEJMra1612499]
8. Kelmendi B, Adams TG, Yarnell S, Southwick S, Abdallah CG, Krystal JH. PTSD: from neurobiology to pharmacological treatments. Eur J Psychotraumatol. 2016; 7(2): 318-28. [DOI:10.3402/ejpt.v7.31858]
9. Khodaie-Ardakani M, Khanjani M, Mirabzadeh A, Bahmani B, Abtahi E, Sadighi G, et al. Effect of exposure to the traumatic event location in war veterans with post-traumatic stress disorder. Iranian Journal of War and Public Health. 2014; 6(2): 10-7.
10. Puetz TW, Youngstedt, SD, Herring MP. Effects of pharmacotherapy on combat- related PTSD, anxiety and depression: a systematic review and meta- regression analysis. PloS One. 2015; 10(5): 652-9. [DOI:10.1371/journal.pone.0126529]
11. Asnis GM, Kohn SR, Henderson M, Brown NL. SSRI's versus non-SSRI's in post-traumatic stress disorder. Drugs. 2004; 64(4): 383-404. [DOI:10.2165/00003495-200464040-00004]
12. MacNamara A., Rabinak CA, Kennedy AE, Fitzgerald DA, Liberzon I, Stein MB, et al. Emotion regulatory brain function and SSRI treatment in PTSD: neural correlates and predictors of change. Neuropsychopharmacology. 2016; 41(2): 611-8. [DOI:10.1038/npp.2015.190]
13. Julien RM, Advokat CD, Comaty JE. Antidepressant. A primer of drug action: comprehensive guide to the actions, uses, and side effects of psychoactive drugs. 12th ed. Tehran. Arjmand Press. 2015; P. 179-80.
14. Nikvarz N, Khalili H, Sahraie Z, Ghaeli P. Pharmacotherapy of neuropsychiatric diseases. 1st ed. Tehran. Arjmand Press. 2013; P. 21-5.
15. Azar M, Nohi S. Common psychiatric drugs. 2nd ed. Tehran. Arjmand Press. 2010; P. 59-62.
16. Kuo MF, Chen PS, Nitsche MA. The application of tDCS for the treatment of psychiatric diseases. Int Rev Psychiatry. 2017; 29(2): 146-67. [DOI:10.1080/09540261.2017.1286299]
17. Nitsche MA, Kou MF, Karrasch R, Wachter B, Liebetanz D, Paulus W. Serotonin affects transcranial direct current-induced neuroplasticity in humans. Biol Psychiatry. 2009; 66(5): 503-8. [DOI:10.1016/j.biopsych.2009.03.022]
18. Davidson J. Vintage treatments for PTSD: a reconsideration of tricyclic drugs. J Psychopharmacol. 2015; 29(3): 264-9. [DOI:10.1177/0269881114565143]
19. Kuo Mf, Paulus W, Nitsche MA. Therapeutic effects of non-invasive brain stimulation with direct currents (tDCS) in neuropsychiatric diseases. Neuroimage. 2014; 85: 948-60. [DOI:10.1016/j.neuroimage.2013.05.117]
20. Kar SK, Sarkar S. Neuro-stimulation techniques for the management of anxiety disorders: an update. Clin Psychopharmacol Neurosci. 2016; 14(4): 330-7. [DOI:10.9758/cpn.2016.14.4.330]
21. Kim JW, Lee, J. Application of transcranial direct current stimulation in psychiatry. J Korean Neuropsychiatr Assoc. 2016; 55(3): 158-67. [DOI:10.4306/jknpa.2016.55.3.158]
22. Arkan A, Yaryari F. The effect of transcranial direct current stimulation (TDCS) on the working memory in healthy people. Journal of Cognitive Psychology. 2014; 2(2): 10-7.
23. Ebadi M, Hosseini F, Pahlevan F, Esmaeeilzadeh-Akhoundi M, Farhadi V, Asqari R. The effectiveness of transcranial direct current stimulation (tdcs) on working memory in patients with major depression. Arak Medical University Journal. 2017; 20(122): 38-47.
24. Vafaye- Sisakht S, Ramezani K. The effects of transcranial direct current stimulation on mental health of veterans with psychiatric disorders. Shefaye Khatam. 2017; 5(2): 36-42. [DOI:10.18869/acadpub.shefa.5.2.36]
25. Dittert N, Huettner S, Polak T, Herrmann MJ. Augmentation of fear extinction by transcranial direct current stimulation (TDCS). Front Behav Neurosci. 2018; 12: 76-82. [DOI:10.3389/fnbeh.2018.00076]
26. Hampstead BM, Garcia S, Schlaefflin S, Porter KE, Smith ER, Martis B, et al. HD- TDCS for combat related PTSD: a case series. Brain Stimul. 2017; 10(2): 514-22. [DOI:10.1016/j.brs.2017.01.500]
27. Van't Wout-Frank M, Reddy M, Greenberg B, Philip N. Combining transcranial direct current stimulation with virtual reality exposure for PTSD. Biological Psychiatry. 2017; 81(10): 258-66. [DOI:10.1016/j.biopsych.2017.02.506]
28. Van't Wout- Frank M, Shea T, Larson VC, Greenberg BD, Philip NS. Combined transcranial direct current stimulation with virtual reality exposure for posttraumatic stress disorder: Feasibility and pilot results. Brain Stimul. 2019; 12(1): 41-3. [DOI:10.1016/j.brs.2018.09.011]
29. Van't Wout M, Longo SM, Reddy MK, Philip NS, Bowker MT, Greenberg BD. Transcranial direct current stimulation may modulate extinction memory in posttraumatic stress disorder. Brain Behav. 2017; 7(5): 681-92. [DOI:10.1002/brb3.681]
30. Delavar, A. Theoretical and practical research in the humanities and social sciences. 9th ed. Tehran. Roshd Press. 2011; P. 315-23.
31. Brunoni A, Nitsche M, Loo C. Transcranial direct current stimulation in neuropsychiatric disorders. 1st ed. Switzerland: Springer International Publishing. 2016. [DOI:10.1007/978-3-319-33967-2]
32. Stein MB. Pharmacotherapy for post-traumatic stress disorder in adults. (2015); https://www.uptodate.com/contents.
33. Baker DG, Lerman I, Espejo EP, McLay R. Treatments for Post-Traumatic stress disorder: pharmaceutical and electrophysiologic considerations. Current Treatment Options in Psychiatry. 2015; 2(1): 73-85. [DOI:10.1007/s40501-015-0035-8]
34. Koenigs M, Grafman J. Posttraumatic stress disorder: the role of medial prefrontal cortex and amygdala. The Neuroscientist. 2009; 15(5): 540-8. [DOI:10.1177/1073858409333072]
35. Marin MF, Camprodon JA, Dougherty DD, Milad MR. Device-based brain stimulation to augment fear extinction: Implications for PTSD treatment and beyond. Depression and Anxiety. 2014; 31(4): 269-78. [DOI:10.1002/da.22252]
36. Mungee A, Kasser P, Feeser M, Nitsche, MA, Schiller D, Bajbouj M. Transcranial direct current stimulation of the prefrontal cortex: a means to modulate fear memories. NeuroReport. 2014; 25(7): 480-4. [DOI:10.1097/WNR.0000000000000119]
37. Aslan EA. Up-to-date psychopharmacological treatments in post-traumatic stress disorder. Klinik Psikofarmakoloji Bulteni. 2018; 28: 332-9.
38. Batsikadze G, Paulus W, Kou MF, Nitsche MA. Effect of serotonin on paired associative stimulation-induced plasticity in the human motor cortex. Neuropsychopharmacology. 2013; 38(11): 2260-7. [DOI:10.1038/npp.2013.127]
39. Pulagar VM. Direct electric stimulation to increase cerebrovascular function. Front Syst Neurosci. 2015; 9: 54-62. [DOI:10.3389/fnsys.2015.00054]
40. Kuo HI, Paulus W, Batsikadze G, Jamil A, Kuo MF, Nitsche MA. Chronic enhancement of serotonin facilitates excitatory transcranial direct current stimulation-induced neuroplasticity. Neuropsychopharmacology. 2016; 41: 1223-30. [DOI:10.1038/npp.2015.270]
41. Averill LA, Purohit P, Averill CL, Boesl MA, Krystal JH, Abdallah CG. Glutamate dysregulation and glutamatergic therapeutics for PTSD: Evidence from human studies. Neurosci Lett. 2017; 649: 147-55. [DOI:10.1016/j.neulet.2016.11.064]

XML   Persian Abstract   Print

Volume 8, Issue 1 (Winter - 2019) Back to browse issues page